A Very Constructive Meeting

Thursday 4th October finally arrived. Bringing the City Hospital Supporters team together did give me moments of anxiety, but we made it in the end with four members of the local community, two GPs from the area, two Acute General Surgeons, two Trauma and Orthopaedic Surgeons, a Senior Physician, a Senior Paediatrician, a representative of all the non-medical staff at City Hospital and yours truly.

We met four Panel members with two from their Secretariat. The IRP arranged to record everything that was said so the Anne Gibson Room was wired for sound. The Panel arrived promptly at 2pm and there were introductions all round. The Panel began by explaining to City Hospital Supporters what they had been doing so far. I then began our presentation using Powerpoint and after about half a dozen slides handed over to the members of the local community and the GPs.

Members of the community stressed to the Panel the importance of having City Hospital providing a comprehensive range of Emergency Services that were fully supported. They stressed the terrible problems the locality faced. They spoke from first hand as either their families or their friends had needed care at the hospital. They spoke very highly of the care that they had received there.

One lady had thoughtfully travelled from City Hospital to Sandwell Hospital on the bus and back again. It had taken 1 hour and 35 minutes, excluding waiting time and cost £4.80. She had also tried it by car on two occasions, considerately avoiding the rush hour. The mileage for a single journey varied between 5.1 and 5.9 miles depending on route, and the time taken had varied between 20 and 35 minutes. On arriving at Sandwell a very real problem was the parking. For completeness our thoughtful member enquired about the cost of the taxi fare from City to Sandwell and it was £8 each way. During the presentation it was pointed out to the Panel that 50% of our population relied on public transport.

The GPs just could not understand why the Trust wished to lose Emergency Surgical and Children's beds and they felt it was quite unacceptable. They were very complimentary about City Hospital saying that it was the hospital that accepted emergency referrals with alacrity and without question. They also both made the important point that GPs on the patch had not been consulted. Perhaps one or two GPs with management roles in the Heart of Birmingham Primary Care Trust had given their views on the Trust's proposals, but it would seem those views were not aligned with their colleagues at the coalface. Prior to the meeting the most senior GP had confided to City Hospital Supporters that he did not wish to be identified because he was concerned about the possible consequences and he felt the same applied to many GPs in the area.

The Panel went on to hear about City Hospital Supporters concerns about the failure of the Trust to conduct a proper Impact Assessment of their proposed changes to the service on the different ethnic groups served by the Trust. The absence of any mention of the problems of going out to consultation with such an ethnically diverse and socio-economically deprived population in the specification for the contract for the consultation process.

It was a long list of problems which included a failure to mention in plain language of any description that the important consequence of implementing the Trust's plan was that sick children and surgically ill adults needing longer than 24 hours in hospital would face a further journey by ambulance for no medically justifiable reason.

Further problems with the consultation that were touched upon included a failure to circulate the document to the target population, a need to be able to leave a message on an Answer Phone in English or navigate a website in English to be able to download a version in the relevant language. A lack of awareness that an inability to read in that language is not uncommon. City Hospital Supporters had looked into the English reading age required to comprehend the document Shaping Hospital Services for the Future. It was in excess of 17 using the Fry Readability Graph which is the reading age required for a newspaper such as the Times. Using the Frisby Formula the Reading Ease Score was 27 indicating 4.5% of an average population would understand it and the IQ required for comprehension was 126+ which is superior and required for reading a scientific magazine.

The Panel heard that of the consultation forms returned only 15.6% were from the Black and Ethnic Minorities, whereas they represent 45.9% of City Hospital's inpatient population. It was also pointed out to them that the Black and Ethnic Minority population of Sandwell Hospital is 13.4% and all these figures are either the Trust's own data or from QUAD RESEARCH who conducted the consultation. A key issue that emerged here was that City Hospital patients containing three times the Black and Ethnic Minorities attending Sandwell would be the ones to receive an inferior quality service. The Panel were reminded that a complaint has been made to the Commission for Racial Equality. This is currently being processed although it is delayed because the CRE is changing to become the Commission for Equality.

At this stage the Panel were reminded that in spite of all the problems with the consultation the Emergency Surgical plan had been rejected by 47% to 31% and losing Inpatient Paediatrics at City by 46% to 29%. The margins were likely to have been wider if the target population had been properly consulted.

We moved on to the Consultant Ballot that rejected the proposed changes to Emergency Surgery and Children's Services by a majority of 97% of those voting, where the turnout was 60% and the overall majority 58%.

Subsequent meetings of City Hospital's Medical Staff Committee rejected the concept of sick patients of any specialty arriving at City Hospital and having to be moved to another hospital for non-medical reasons, putting them at increased risk and the whole family to enormous inconvenience.

We went on to consider the reasons that the Trust had chosen Sandwell Hospital as the site for concentrating Emergency Surgery. City Hospital Supporters were perplexed that no single reason was put forward about any benefit for Emergency Surgery patients and indeed the last reason put forward by the Trust was that if patients were really stuck there were other hospitals in Birmingham that they could go to such as UHB or Heartlands!

We then looked at the reasons put forward by the Trust for proposing the changes, and then went on to hear from the doctors directly concerned. These reasons were rejected quite emphatically. It was at this point that the Panel invited the surgeons to come forward with their plan ensuring that they were able to meet the necessary requirements. Our surgical colleagues have accepted the challenge and have gone away to commit their plan to paper and present it to the Panel in the near future.

The Children's doctor present handed to the Panel a document setting out the plan from the Children's doctors at City Hospital that would retain some beds at the hospital, meet all necessary requirements and save the Trust £500,000 a year.

Nearly two hours had passed remarkably quickly. It had been a very good meeting. The Panel had been extremely attentive and had asked some searching questions. There was good interaction between the Panel and City Hospital Supporters. We thanked each other and then thankfully retired for tea and Panel members then faced the long journey home. We were most grateful for their time and trouble.

There is one very troubling issue, and that is Children's Services. Unfortunately the Birmingham Council Health Scrutiny Committee did not refer Paediatrics to the Secretary of State for Health back in May this year just Emergency Surgery. It is City Hospital Supporters belief that the Scrutiny Committee may have been misled and this is being pursued. It would appear from everybody but the Secretary of State that the IRP are not able to consider Paediatrics. This seems to be a remarkable example of where due process is getting in the way of doing the right thing. It is clear to City Hospital Supporters that a grave injustice is being done to the people served by City Hospital. Emergency Surgery has the chance of reprieve, but the little children are condemned to an inferior service. Can that be right?

After this meeting I went home and had another look at the letter from the Secretary of State for Health to the Chairman of the IRP Dr. Peter Barrett. I am reproducing it here because I feel it is important for others to see it:

From the Secretary of State for Health Alan Johnson to the Chairman of the IRP Dr. Peter Barrett.

"TERMS OF REFERENCE
The Panel is asked to advise the Secretary of State by Friday 30 November 2007:
(a) whether in the light of the grounds of referral as set out in the correspondence from the Birmingham Health Overview and Scrutiny Committee to the Secretary of State of 18 May 2007, it is of the opinion that the proposals to consolidate emergency surgery provision at Sandwell Hospital, as set out in the decision of Sandwell and West Birmingham NHS Trust Board on 10 May 2007 will ensure safe, sustainable and accessible services for the people of Sandwell and West Birmingham, and if not, why not;
(b) ON ANY OTHER OBSERVATIONS THE PANEL MAY WISH TO MAKE IN RELATION TO THE PROPOSALS FOR CHANGES TO EMERGENCY SERVICE PROVISION AND IMPLICATIONS FOR ANY OTHER CLINICAL SERVICES;
(C) IN THE LIGHT OF (A) AND (B) ABOVE ON THE PANEL'S ADVICE ON HOW TO PROCEED IN THE BEST INTEREST OF LOCAL PEOPLE."

Now if that does not apply to Paediatrics I do not know what else it can be. I have written to the Secretary of State pointing out my concerns that his letter is being misinterpreted somewhere, I suspect in the Department of Health. I did get a reply to my letter not from the Secretary of State, but from a Mr. Alan Addison in the Customer Service Centre of the Department of Health. He closed the door firmly on the little children citing the Birmingham Scrutiny Committee as the reason.

The question is should we just accept the word of somebody in the Customer Services Department of the Department of Health. I am not their customer. City Hospital Supporters are not their customers. The children of West and Central Birmingham are not their customers. They are potential patients needing high quality patient care when it is required by their local hospital without facing any increased risks or inconvenience. City Hospital Supporters is going to continue to fight for them and for their right to TRUE EQUALITY OF ACCESS TO HIGH QUALITY HOSPITAL CARE.

DO YOU THINK WE ARE RIGHT OR DO YOU AGREE WITH MR. ADDISON IN CUSTOMER SERVICES AT THE DEPARTMENT OF HEALTH?

WE NEED YOUR SUPPORT ON THIS ONE AND THE CHILDREN CERTAINLY DO!
LET US HAVE YOUR COMMENTS PLEASE.