Wednesday, August 22, 2007


It is turning out to be quite a week. There has been the excellent paper from the people at Sheffield showing that the further seriously ill patients are transported to hospital, the greater the risk and the higher the mortality.

Why is this so amazing I can here everybody asking? We all knew that, it's only common sense! Yes but nobody has done a careful study and proved it to be a fact until now. Now it has been done and the results are unequivocal.

Now we have the evidence it should influence policy. As a physician I always try to practise evidence-based medicine. Surely the organisation of care should be evidence-based? Indeed one of the great causes that I believe the entire medical profession would unite behind is that government should use available evidence as the basis for all its health policies and plans.

I suspect the profession would also agree that there are serious issues with the advice that government receives. This should be about "horses for courses." If you want advice on emergency medical care, ask a doctor who has a great deal of experience in that area.

Another pitfall is building your plans around a collection of individual professional perspectives. The Cancer Tsar will have one set of recommendations, the Heart Tsar another and so on. They could well pull in quite different directions. Add in various statutory requirements such as the EWTD and MMC and you have all the ingredients for a complete shambles.

Common sense and talking to patients over many years brings out the really important themes. Patients want to see their GP when they are ill. When they are acutely ill they would also like to see the GP, preferably the usual GP. Patients think continuity of care is quite important. They like doctors and nurses that understand them. People they can trust. How can you trust anybody when you have only just met them once? Trust is built over time. They do not want GPs masquerading as Consultants or vice versa. They do not want nurses replacing doctors or health care assistants replacing nurses. Informed patients understand the "concept of dumbing down" and the affluent and insured consult the internet and find their specialists.

When patients are really ill they want to go to their local hospital until they are better. They would like their common serious illnesses managed under one roof but appreciate they may have to be moved for something very clever. They do not believe that closing or downgrading their local A&E Department is an improvement and suspect ulterior motives quite rightly in my view. They are also quite rightly extremely suspicious and sceptical about treatment in or nearer their own homes. They also find this difficult to equate with losing services from the local hospital.

Now how does all this bear on City Hospital. Well under current plans the sick children and surgical adults would have to face that additional ambulance journey of six miles minimum, more if Sandwell had run out of beds. Current plans clearly do not make sense.

Lastly I hear from Louis that the Sandwell and West Birmingham Hospitals NHS Trust has blocked this website for the staff at City Hospital. I wonder why? Has hospital productivity fallen because everybody is so busy eagerly scanning this website? I doubt it. Could it be something to do with preventing the staff hearing the other side of the argument? When an organisation blocks freedom of communication warning bells should be sounding. It suggests they are on the wrong course. A healthy organisation is one open to and welcoming of criticism and confident enough in its own evidence-based decisions to allow all its staff access to all the arguments. I suspect banning us will lead to more hits than ever so we must watch the website monitor most carefully. (Update 29/08: The website appears to be accessible from Trust premises again. Someone must be paying attention!)



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Tuesday, August 21, 2007

Cameron Visit Sandwell, Report Condemns Plans

A lot of national news stories relevant to the campaign hit the news today. The Stirrer has an excellent article here including an interview with Ken Taylor over the criticism of A&E closures by the Medical Care Research Unit at Sheffield University.

Also, David Cameron visited Sandwell Hospital today amid criticism by the press over his claims that 29 district general hospital are facing cuts to emergency and maternity services. One of the 29 hospitals the Conservatives are referring to is City Hospital, Birmingham.

Now I do not know about the other hospitals, but the mainstream media coverage seem to be getting bogged down in petty political points scoring. Sandwell & West Birmingham Hospitals NHS Trust are quoted here on the BBC in the following manner:

Sandwell and West Birmingham Hospitals NHS Trust said there was "no threat" to the accident and emergency department nor the maternity unit at City Hospital in Birmingham.

Trusts react

Other NHS trusts have also contradicted the Conservative claims.

Quite frankly, I think this is sloppy reporting. It is an indisputable fact that emergency general trauma and surgery and emergency paediatric services are under grave threat at City Hospital. Anyone who says otherwise has not done their homework. The Trust delivered a typical communications tactic of concentrating on what is not changing at the hospital, and the national BBC reporter has fallen for this line hook line and sinker (this is in contrast to the excellent local BBC reporting of the issues on the Radio WM, Midlands Today and the Politics Show who have sought balance by interviewing both the Trust and the City Hospital Supporters Group in an attempt to get to the truth.

In other news it seems this site has been blocked by the Trust, so you will have to access this site at home in future to keep up with campaign news. If you are reading this, I guess you already knew that. (Update 28/08: This site seems to be accessible from Trust computers again. Someone must be paying attention!)


Sunday, August 19, 2007

Next Meeting of City Hospital Supporters

Will be on Tuesday 4th September at 12.30pm in the Anne Gibson Room close to the Postgraduate Centre. It is a meeting open to all members of the Group and I hope as many as possible will attend.

It will be an opportunity to hear about all the activities over the summer, and discuss the imminent visit of the Independent Rconfiguration Panel to Birmingham to review the Trust's plans for Emergency Surgery. We have not received any dates as yet but understand it wil be during September and October.
Please do your best to join us.


Wednesday, August 01, 2007

Bed Numbers.

It has been pointed out to me that I have used an incorrect figure for the bed complement at City Hospital. Having carefully researched the matter I realise that the figure of 1100 beds was historical going back to the time before a previous management had enhanced the size of the car park by demolishing the wards for elderly patients, thus thrusting West Birmingham into the mainstream of care in the community. It also saved money by removing the need to pay the capital charges and saved on the maintenance bill.

Getting accurate data on beds is always difficult because it is frequently changing. Should we consider only beds that are open, or take into account those that are closed whether it be permanently or temporarily?

The data I now present was obtained from very reliable sources on the 1st August so it is bang up to date.

The potential full bed complement for City Hospital is 715 beds. However the following wards are closed:
Two Elderly Care Wards on Sheldon Block each containing 28 beds.
M8 the Rheumatology Ward containing 17 beds.
D29 Ward containing 17 beds.
D28 Ward containing 17 beds.
D22 Ward containing 18 beds.
D19 Ward containing 20 beds.
D9 Ward containing 20 beds.

Total beds closed 165.

If we subtract 165 from 715 we get the current bed complement at City Hospital which is 550.

Now let us look over to the other half of the Trust.

Again the data was obtained today:
The potential full bed complement for Sandwell General Hospital is 397 beds.
However believe it or not Sandwell has:
Priory 3 Ward closed, an Acute Cerebrovascular Accident Ward 28 beds.
Lyndon 4 Ward, a Medical Ward is closed 32 beds.

So with 60 beds closed Sandwell's current bed complement is 337 beds.

What about Rowley Regis Hospital?
This hospital has 84 beds for Rehabilitation and mercifully they are all open.

Why are so many beds shut? A very pertinent question. In purely financial terms beds means nurses. Less beds means fewer nurses. There is a big turnover in nursing staff and it is easy to reduce the nursing complement to match the bed complement by restricting recruitment. Furthermore it is possible to reduce the bank and agency nursing bill. So good news the financial deficit has been miraculously transformed but there has been a price.

If we consider the closed beds as a percentage of the total bed stock, 23% are closed at City and 15% at Sandwell if we ignore Rowley Regis Hospital, or 12% if we include it.
City Hospital remains the larger hospital but if this differential closure rate were to continue the hospitals could become of similar size in bed terms.

Within the last few weeks a very good friend of mine a senior gentleman was admitted to City Hospital. He presented with a severe bout of pneumonia and needed IV antibiotics and the care of the physicians. He was full of praise for the medical and nursing staff. He thought the nurses were a greatly committed bunch of people. However he was rather dismayed to have been nursed on the ladies ward. He did not mind too much but he felt really sorry for the ladies!
Do we need those beds? You bet we do.