New Year's Demo at City

Despite the best attempts by the powers that be to bury the bad news, demonstrators turned out yesterday to campaign against the downgrading of City Hospital's A&E service which was recently rubber stamped by the government funded "Independent" review panel. This article in the Stirrer implies that it is a stitch-up by Sandwell, but I am not convinced; this whole episode is just another example of the incompetence of the Trust board that happens to be less worse to Sandwell than it does Birmingham. After all, as the article points out, if the new hospital ever gets built, Sandwell effectively loses its hospital, despite claims to the reverse of the Trust Board.

Well done to all those who turned up. The fight is not over.

Some sobering thoughts for 2008.

2007 is ending on a sad note for the people relying on City Hospital for its care. Impossibly bad decisions have been made affecting the future of that hospital by people who neither have the interests of the patients or the hospital at heart.

As a result of City Hospital Supporter's efforts we will see a 24 Hour Children's Assessment Unit and hopefully a 24 Hour Surgical Assessment Unit but essentially these two groups of patients have been condemned to second class care like no other patients in Birmingham.

The management of the Hospital Trust is pushing ahead with its plans for children and surgical services which do not have the support of the community served by City Hospital or the consultant medical staff working there. These plans will provide a worse service for patients and relatives and have been shown to be unnecessary by the relevant staff with the children's doctors even producing a plan that would have saved the Trust a lot of money.

It was very unfortunate that the Birmingham Health Scrutiny Committee referred only the proposed changes to Surgical Services to the Secretary of State but not those to Children's Services. This immediately laid that Committee open to the criticism that if they would permit children to be treated in this way then what was wrong with it for surgical patients?

City Hospital Supporters always had doubts about the word "Independent" in the title of the Independent Reconfiguration Panel. It is a government-funded body with close links to the Department of Health. This Panel demonstrated its alignment right at the start by appointing the local Director of Reconfiguration who had drawn up the plans to which we were objecting as their lead person organising the timetable of visits. Our concerns strengthened when the Panel refused to hear anything related to Children's Services. Clearly they felt they could save time here if they had no intention of objecting to the plans for Emergency Surgery. Furthermore although they were considering services to surgical patients they did not have a surgeon on the Panel. The only doctor was a Medical Oncologist not a surgeon. Turning to their account of their findings on the website it is notable that they do not record that they met a fourteen person team from City Hospital Supporters Group nor do they provide any coverage of the case that was presented with supporting evidence. The Trust's position is restated and none of the statements are challenged. Having spoken to a number of people there is agreement that the Reconfiguration Panel is a rubber stamp for the Trust's plans and their assessment is completely worthless.

The community served by City Hospital need to remember that the Heart of Birmingham Primary Care Trust has been complicit in these plans. Their local MPs have done nothing to stop the downgrading of their services, worth bearing in mind when election time comes round once more.

What of the future? The Trust is going for "Foundation status." Do they really have the confidence of the local community? The community whose opinion they asked during the consultation and then ignored it completely. Is this what local accountability is all about? The future is meant to be all about polyclinics with as much as possible being treated in the community. Will this give better patient care? There is no evidence that it will. Will it be cheaper? Almost certainly not the case. Will it be at the expense of hospital care? We fear that it will be. Apparently the only buildings to be left standing on the City Hospital site will be the Birmingham Treatment Centre, the Sheldon block and the Birmingham Eye Centre. No doubt the rest of the site will be cleared and the land sold to the developers for housing and shops.

Will there be a new hospital on the Grove Lane site within the next ten years? Do Sandwell residents want to travel to within a mile of City Hospital for their care? If they do why not go the extra mile and use the land that is already available on the City Hospital site, saving much time, money and trouble.

After all the expenditure of capital money in the community will there be enough for a new hospital? Is the plan to leave the hospital care needs of West Birmingham to the newly rising University Hospital? Will there be enough room in this new hospital? It will be accommodating the patients from the QE and Selly Oak as well as providing for many Regional Specialties. Additionally we are going to see a new town rising on the rubble of Longbridge which will add significantly to the catchment population. Will it cope? Will there be enough beds? Will the numbers of people trying to gain access to this super hospital as patients or visitors overwhelm the transport infrastructure?

If the SWBH Trust, the Heart of Birmingham Primary Care Trust and the Reconfiguration Panel had really been thinking about the welfare of the people of West Birmingham they would have maintained full services at City Hospital until the new hospital opened its doors. The fact that this has not happened more than anything else must cast serious doubt on the long-term intentions of these people.

IRP Reach Wrong Decision

We were under the impression that the IRP would be reporting in January as per our previous post, so I was shocked to find this announcement on the BBC that the IRP and the Secretary of State had backed the Trust's proposals to remove emergency inpatient surgery beds from City hospital, ignoring the views of the medical profession at City and the patients who use the services and instead backing the managers who have overseen a transformation from a three star Trust back in 2003 to a Trust that was rated 'fair' in Quality of Services and 'weak' in Use of Resources in 2006. Please also see the following links for reactions:

http://www.thestirrer.co.uk/1912072.html

http://deirdrealden.blogspot.com/2007/12/bad-news-for-birmingham.html

The consensus is this is an attempt to "bury bad news" over the Christmas season in an attempt to avoid protests.

Despite following quite closely the campaign via Ken Taylor as part of the City Hospital Supporters Group, there had been absolutely no indication that this was coming. It is an absolutely disgraceful way to treat the patients who pay for hospital services via taxation, but then do not seem to get their views listened to when a "consultation" takes place

I am sure Ken Taylor's reaction will follow soon.

When do we hear the verdict of the Independent Reconfiguration Panel?

The answer is mid-January 2008. Apparently the report of the Panel goes to the Secretary of State at the end of November and would normally be made public at the end of December, but because of Christmas it will be delayed by about a fortnight.

Children's Beds Closed at City Hospital 5th November

The Sandwell and West Birmingham Hospitals NHS Trust went ahead and closed the children's beds at City on the 5th November. The views of local people expressed as a decisive vote, the views of the consultant medical staff at City Hospital have been completely ignored.

The Trust have produced a 38 page Operational Policy for their new Children's Assessment Unit and a 21 page Children's Transfer Policy. Staff will turn over quite rapidly at both hospitals. Just imagine the scope here for confusion!

Let us look for a moment at what the Operational Policy for the Children's Assessment Unit has to say about General Practitioner Referrals. All calls to the children's doctors at City will go to the Sandwell Children's Registrar. Apparently children may be triaged over the phone and sent to the inpatient unit at Sandwell. No choice here for parents or children. This makes a complete nonsense of the government's choice agenda, at least as far as the deprived area of West Birmingham is concerned. Everybody else gets their children cared for at their local hospital.

Apparently if it looks as if a child needs less than 23 hours in hospital, the GP will be able to send the child to the Children's Assessment Unit at City. However if the child fails to beat the clock and the 23 hour deadline is looming then it's off to West Bromwich.

Interestingly they have a plan. If the beds are full in the City Hospital Children's Assessment Unit, a child may need to be "accommodated" in the Emergency Department. Is this high quality care?

There will be only 12 beds on the Children's Assessment Unit. This sounds like a totally inadequate number to me. This probably explains why they are clearly worried about what to do when 10 of them are full. There is talk of the poor Senior House Officer or Registrar "reviewing the situation" and ascertaining any possible discharges or transfers. "In extreme circumstances and for short periods of time, children awaiting discharge will vacate their beds and step down into a chair or an extra bed flex-up will be utilised while discharges and/or transfers are arranged."
Real 21st Century Care for the children of West Birmingham!

The West Midlands Ambulance Service has been requested not to bring any child requiring "blue light" ambulance transfer to City Hospital Emergency Department. As Birmingham Children's Hospital is only increasing its bed complement by three where will these poor children go? To Sandwell if they have a bed, if not further afield, Heartlands? Good Hope? the Manor Walsall? Who knows?

It continues: "Any seriously ill unstable child/young person will remain in the Emergency Department until they are stable enough for transfer to the Children's Assessment Unit. If they are likely to need inpatient stay over 23 hours they will be transferred to the inpatient unit (Sandwell) as soon as they are stable enough for transfer in an ambulance from the Children's Assessment Unit."

We have moved from a high quality Children's Service at City Hospital where children received all their care under one roof to one where the children will be moved from pillar to post. Continuity of care will be a nightmare. The changing junior medical and nursing staff will need to keep the script with them in order not to lose the plot.

This inferior service has been thrust on local people for no supportable reason. There was an alternative plan that would have kept the lights on in the Children's Ward at City Hospital but it was ignored by the Trust Management.

An Absolute Disgrace!

Unless a miracle happens a grave injustice will be done on the 5th November when 18 children's beds currently at City Hospital in Birmingham are moved to Sandwell Hospital in West Bromwich.

Up to 1800 children go through these beds in a year that is between 4 and 5 children a day. These children are from one of the poorest and most deprived districts in the UK. Many of these children are from the ethnic minorities. The consequence of this change of location of the beds is that sick children will face an additional and unnecessary ambulance journey putting the young patients at increased risk, and their parents to increased inconvenience.

This is not happening like much in the health service for any sensible reason that can be justified. Indeed the children's doctors at City Hospital have produced a workable plan that would enable the beds to remain at City, meet all requirements and save the Trust managing the two hospitals about half a million pounds per year.

During the consultation the people were asked to vote on the changes to children's services. They did so and rejected the proposals by a sizeable majority.

Emergency Surgical patients also faced losing their beds at City Hospital and still do. However the Birmingham Health Scrutiny Committee decided they were very unhappy about this aspect of the proposal and so referred it to the Secretary of State for Health who in turn referred it to the Independent Reconfiguration Panel. They will not be presenting their report and recommendation until the 30th November.

Why the Birmingham Health Scrutiny Committee were worried about the surgical patients and not the children God only knows.

Why is the Sandwell and West Birmingham Hospitals NHS Trust rushing ahead to move the children without waiting for the outcome of the Independent Panel? The Trust has been asked by one of the city's MPs to hold off the move until the Panel reports. The outcome of that request is still awaited.

If the Trust do not do so and proceed with the move of the children and the Independent Panel decide the Emergency Surgical beds should remain at City, we will be in the ludicrous situation that a move is considered unsuitable for adults but OK for children!

At present the outlook for the children of Birmingham that will be affected looks bleak. If this thoroughly unnecessary change in emergency service provision goes ahead a lot of people should not rest easy with their consciences. Before it is too late they must ask the question what could I do to prevent this bad thing happening to these children. This could apply to the Trust management,the Heart of Birmingham Primary Care Trust, the Strategic Health Authority, the Birmingham Health Scrutiny Committee, the Department of Health, the Birmingham MPs, Birmingham Councillors and the media.

November the 5th is the 400+ anniversary of a tragic event in British history. Guy Fawkes and fellow conspirators plotted to blow up the Houses of Parliament. It was a Catholic plot against a government ruled over by the Protestant King James 1. It was one of the milestones of this country's evolution to a modern democracy.

How far have we come and how democratic are we? We are just about to allow some children in the city to have an inferior quality of care forced upon them. The local population voted against it. 97% of the consultants at City Hospital voted against it.
Why are they proceeding with it?

The Presentation to the IRP

Click here for the presentation that was given to the Independent Review Panel regarding the proposed interim reconfiguration plans which affect City Hospital's emergency & trauma surgery and emergency paediatric beds. It provides a concise summary of the arguments against the proposed reconfiguration, and is well worth a look whether you have been aware of this campaign from the start or are new to the arguments.

You do not have to sign into google to view the presentation. Just click on the link "View published presentation in a new window" to open the slideshow. To navigate through the slideshow, either use the arrows in the bottom left-hand corner of the screen or just click anywhere on the screen to view the next one.

Personally, I believe that this presentation blows the arguments of the Trust away. Given the size, support and arguments made by the City Hospital Supporters Group, if we do not get the Trust's decision overturned, it really begs the question as to what we, the users and taxpayers of our National Health Service have to do to decide how our money is used to treat our health needs.

NB: Due to the conversion from a powerpoint presentation to a web based presentation, there may be some problems with formatting on the version above. An alternative version is available here where you have to click to progress the sideshow point by point. Rest assured that these were perfect when we presented to the IRP!

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.

Meeting the Independent Reconfiguration Panel (IRP)

City Hospital Supporters have waited a long time for this opportunity. It will happen on Thursday 4th October at City Hospital. We have a representative group meeting the Panel consisting of some members of the community and representatives of the staff non-medical and medical. We will be making a presentation which we hope at some stage after the event to make available via this website.

I know how very worried people are out there. People are concerned that they have not been consulted properly. They find it unbelievable that in these days of a Labour Government seeking a fourth term of office, there are people proposing to move the sick around in ambulances, not for any medical benefit and indeed not for any sensible, rational reason.
Over the last few months I have had the very pleasant experience of meeting many people living close to City Hospital and who have used its services many times over the years. They all speak with great respect and affection for it. They know how important its Emergency Services are to them. They are very glad this Independent Panel is looking at Emergency Surgery, and nobody wants us to abandon the children. We will not do so.

Our fervent hope must be that not only will we get a fair hearing on the 4th October, but that it will lead to City Hospital keeping those beds and continuing to look after its patients properly until that new hospital opens in Grove Lane.

Access from SWBH computers to this website

When many people at the Trust attempt to log on to this website they get the following message displayed:

"Your organisation's Internet use policy restricts access to this web page at this time."

This does not apply to all the Trust's computers but to very many of them.

We have to ask ourselves the question WHY?

Is this an obscene website or where deliberate untruths are told?

Do we block the opportunity for opposing views to be expressed as comments?

Are employees going to be spending large amounts of time reading the material and wasting Trust time?

If the Trust's employees are denied acces to the website at work will they only have the Trust's view on the important issues of the day?

If the Trust had sound evidence and sound reasoning and full staff support behind its reconfiguration proposals would it want to block access to this website?

Would we even need our own website if the above statement were true?

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.

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.

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.

City Hospital Supporters Appeal to New Prime Minister.

A letter was dispatched to Mr. Gordon Brown on the day he became Prime Minister. The idea to write to him was inspired by his declaration that he intended to make the NHS and listening to local people his top priorities. Undoubtedly he has the chance to do so right here in Birmingham with the City Hospital Reconfiguration debacle.

Dear Mr. Brown,
Firstly I am writing this open letter to you on behalf of the City Hospital Supporters Group in Birmingham and we would like to congratulate you on becoming the new Leader of the Labour Party and Prime Minister. We were delighted to hear this most welcome news. We were also very pleased to hear that you were to make the NHS one of your top priorities and were particularly delighted that the views of local people were to be listened to.

City Hospital is the hospital closest to Birmingham City Centre. It serves the 4th most deprived district in England with wards such as Ladywood, Handsworth, Soho and Aston. Its A&E Department saw some 103,000 referrals over the last year with approaching 20,000 children. The hospital has an excellent A&E Department that has developed special expertise as it sees more penetrating injuries from gunshot and knife wounds than any hospital in the Midlands and probably the whole country.

City Hospital Supporters is a recently formed group consisting of members of the community served by the hospital and members of staff of every occupation. We are committed to ensuring that the community continues to receive the same high quality of care they have been used to, provided by City Hospital. This hospital had its own Trust Board until a few years ago and it then merged with Sandwell Hospital NHS Trust. The long term plan is to replace the two existing hospitals with a single hospital in Grove Lane Smethwick that will serve a combined population of 500,000. City Hospital Supporters endorsed this development when it went out for consultation in November last year. The new hospital is but a plan at present at a very early stage. Finance has to be organised throught the Private Finance Initiative, the land purchased and the building plans produced. The new hospital will not open its doors before 2013/14 assuming no slippage.

Our major concern is the Interim Reconfiguration Proposals recently approved by the Trust Board. These proposals would see inpatient Paediatric and Emergency Surgery beds moving from City Hospital to Sandwell Hospital with 24 Hour Assessment Units being established in these specialties at City Hospital. City Hospital is the larger hospital with 1100 beds compared to 400 beds at Sandwell. It serves a socio-economically deprived population and one with a very high concentration of the ethnic minorities. Some 50% of families are without their iwn car and public transport links are not good.

If the Trust's proposals were implemented about six of the children admitted and about 12 of the adult surgical patients who were admitted via the 24 Hour Assessment Units each day would need to be moved to the beds at Sandwell because they needed to stay in hospital longer than 24 hours. These journeys would not be medically necessary as they would not be moving patients to higher levels of care such as Intensive Care or High Dependency beds, they would be moved to ordinary ward beds. This has to be unacceptable care in the 21st century for the hospital at the centre of England's second city.

The actual formal consultation was flawed because the ethnic minority population was not effectively addressed. However those who returned consultation forms rejected the Trust's proposals for Emergency Surgery 47.2% to 31.4% and for Paediatrics 45.6% to 29%.

As if this were not bad enough these proposals fly in the face of the Trust's own Racial Equality Policy. This is because from data provided by the Trust on their website City Hospital has an inpatient population consisting of 45.9% ethnic minorities against Sandwell 13.4%. Thus ethnic minority patients at City would be unfairly disadvantaged and put at greater risk. A complaint has been made to the Commission for Racial Equality and I understand that it is being investigated.

Last week a secret ballot of all the consultants at City Hospital drew to a close. 97% of those retuurning ballot papers supported the prospect of the new hospital but opposed losing the Paediatric and Emergency Surgery beds. Only two ballot papers were received voting the other way and we had an overall majority of 57.9%. No previous ballot had been conducted by the Trust.

I am sure you will agree that this is a totally unacceptable situation, particularly as the Trust did have options on the table that would have preserved Emergency Services at both hospitals until the new hospital is built. These options would have been perfectly acceptable to City Hospital Supporters. The good news is that the Birmingham City Council Health Scrutiny and Overview Committee has referred the Emergency Surgery proposals to the Secretary of State for Health who has to decide if referral should be made to the Independent Reconfiguration Panel. However Paediatrics has not been referred.

This is a very clear example of the local community not being effectively consulted about a major change to the provision of their hospital services. In spite of the flawed consultation they have rejected a reduction in services at their local hospital, but they have been ignored by the Trust. The senior doctors at the hospital have spoken with one voice on the Trust's proposals but to date it has had no effect.
Referral of both the Emergency Surgery and the Paediatric plans to the Independent Reconfiguration Panel would at least give us a chance to present the facts to an independent and external group of people, so that the case for preserving effective emergency services at City Hospital until the new hospital opens could get a fair hearing.
With kind regards and good wishes for the future.

Yours sincerely.

Dr.K.G.Taylor

On behalf of City Hospital Supporters Group.

Informing the Trust of the result.

Today a letter should have reached the Chief Executive and I copy it here for all to see:

Mr. John Adler Chief Executive,
Sandwell&West Birmingham Hospitals NHS Trust

Dear John,
I am writing to formally let you know the method and result of this ballot. The list of consultant staff ballotted was the current list used by the Medical Staff Committee. Each consultant was allocated a number which appeared on the ballot paper and also on the envelope in which the paper was returned. I enclose a copy of the ballot paper. These were sent out the week commencing the 4th June and the closing time was 5pm on the 20th June.

The count took place at the Afro-Caribbean Millennium Centre and the Independent Referee was Mr. XXXXX of the Birmingham Council Health Scrutiny Committee. All the ballot papers received were in envelopes. The envelopes were opened and the ballot papers arranged in numerical order. A check was made to ensure that there was only one ballot paper with each number, and there were no papers without numbers. All the ballot papers had the preference clearly marked.

The number of ballot papers returned was 98 giving a percentage return of 59.7%. 95 of those papers were in favour of the motion i.e. 96.9%. There were two papers cast against the motion and one abstention. The votes in favour of the motion expressed as a percentage of the papers sent was 57.9% this being the overall majority. Thus in the event of all the non-voters having voted against the motion those in favour would still have carried the day.

This is a very clear cut result with good participation, an almost unanimous result on the votes cast and an overall majority.

The message from the consultant staff is absolutely clear. It is that they supported the prospect of the new hospital on the Grove Lane site, but rejected the current interim reconfiguration proposals to move Paediatric and Emergency Surgery and Trauma beds from City to Sandwell Hospital.

In the light of this result I call upon the Trust to reconsider the options available for any interim reconfiguration and select one that does not impact upon the emergency service provision of City Hospital.

Yours sincerely,

Dr. Ken Taylor

On behalf of City Hospital Supporters Group.

cc. Secretary of State for Health and others.

I am sending a copy of this letter to all members of the senior medical staff at City Hospital and no doubt they will be discussing the situation in the near future.

It's Almost Unanimous!!!

At last the senior doctors at City Hospital have expressed their verdict on the Trust's proposals for a new hospital on the Grove Lane site, and in the interim moving inpatient Paediatric and Emergency Surgery and Trauma beds to Sandwell.

95 out of 98 effectively said YES to the new hospital and NO to moving the beds. For the mathematically inclined this is a 96.9% majority of the votes cast. 164 ballot papers were issued using the current medical staffing list for City Hospital giving an absolute majority of 57.9% or in other words if all the non-voters had voted against the motion it would still have been carried. The count today was supervised by an independent referee.

We now have a situation where however flawed the consultation, the proposal to move the Surgical beds was rejected 47.2% to 31.4% and the Paediatric beds 45.6% to 29% by those in the community consulted. In view of the very obvious ethnic issues the Commission for Racial Equality is involved. The Emergency Surgical proposal has been strongly criticised by the City Council Health Scrutiny committee and referred to the Secretary of State, and now the consultants at City have spoken with one voice endorsing the view of those consulted.

Can there be a louder or clearer message to those managing the Trust?

Would the majority of senior doctors have rejected the interim reconfiguration proposals if they had felt there were essential reasons for moving the beds to Sandwell?

Now is the time for the Trust to be reviewing the situation. There ARE other options. PROTECT the emergency services to the local community. The people NEED them.

Can somebody, anybody tell me why oh why are we having to fight to prevent something really important being taken from those with the greatest need?

I now understand what Julian Tudor Hart meant. He is an eminent and greatly respected Welsh GP. He is a youthful octogenarian but an angry one who invented the" inverse care law" back in 1971.

This law states that "those people most in need of health care tend to receive the poorest service."
This must not happen in this great City of Birmingham to our people, and we must do all in our power to prevent it happening.

A final point, it would be good to hear from some of you reading this blog. If you click on comments at the end of this piece you can have your say. I know people are worried about identifying themselves, so just adopt a pseudonym or perhaps use a christian name. This website is for all those people who wish to stand up and support good hospital care for the people local to City Hospital.

Vote, Vote, Vote!

This is a timely reminder to all the senior doctors at City Hospital to make sure that they vote in the secret ballot and return their voting papers by next Wednesday 20th June.

The Motion is lengthy for good reasons but the message is very simple:

We are FOR investment in a nice new hospital on the Grove Lane site.
We are AGAINST moving the Children's beds and the Emergency Surgical and Trauma beds from City to Sandwell Hospital while we wait for the new hospital.

There is a simple choice for voters, IN FAVOUR or AGAINST.
There is no option for those who are undecided except perhaps not to vote. I would like ALL those eligible to vote. Naturally I would prefer them to vote in support of the motion. However actually voting is the most important thing. Disagreement among human beings is essential for progress. We learn from different views being expressed. It is a great strength of the human race. It is how we resolve our disagreements that is important. Letting people decide at the ballot box recognises that the majority must determine what happens in a fair and free vote.

Why a secret ballot? It takes all outside pressures off the voters. Each individual can follow his/her conscience without fear of peer pressure or reprisals from any quarter. No names are required just a cross on the paper.

The ballot papers are numbered to ensure no duplicates. The sealed envelopes are numbered so they can be ticked off from the list to ensure people have voted. These lists will not be available when the sealed envelopes are opened and will be destroyed when our independent assessor from outside the Trust is content all is in order.

DO MAKE SURE YOU VOTE!!!

Adler Anger at (Genuine) Consultation

Ken Taylor has been organising a ballot for the Consultants at City on whether or not they support the Trust's interim reconfiguration plans. This seem to have put the wind up the Trust Board a little, as can be seen in the following letter to Ken Taylor from the Chief Executive (click on the letter to enlarge).

Ken has responded to the letter in the following fashion (a printable copy is available here):

Mr. John Adler,
Chief Executive,
Sandwell and West Birmingham Hospitals NHS Trust,
Trust Headquarters,
City Hospital,
Dudley Road,
Birmingham B18 7QH. 11th June 2007.

Dear Mr. Adler, Re: Ballot of City Hospital Consultants.

I was really disappointed to receive your letter today, both with regard to its content and its tone. In organising the ballot, City Hospital Supporters are giving the consultant medical staff at City Hospital the opportunity to express their opinion on the plans for the new hospital and the service reconfiguration in a truly democratic, fair, private and time-honoured way. We have done our best to make sure the doctors are aware of all the new developments such as Race Equality issues and the matter of the Birmingham City Council Health Scrutiny Committee’s response to your proposals, as well as the resounding rejection of the reconfiguration plans by the consultation process flawed as it was. There are ethical issues here for doctors who do have a wider responsibility to all members of the community served by the hospital. We also pointed out to them that apparently the West Midlands Strategic Health Authority is already under the impression that your proposals have clinical support, although admittedly they do not state where that support is based, and how it was obtained. Surely some clarification now would be most timely?

I would like to reassure you that Trust resources are not being squandered by City Hospital Supporters. The cost of materials such as paper and envelopes is being borne by Unison or City Hospital Supporters. This was made clear to ***** at the start of the campaign. I am sure ***** has only done things for us in her own time, because I know she comes into the hospital very early at around 7am. If we owe any money to the Trust, it will be reimbursed.

This ballot could go either way. We have given the consultants a choice. It was our intention to ask you to nominate a person to represent the Trust at the count to ensure that all was in order. This offer still stands. However if you do decline to nominate somebody we shall identify an impartial and respected individual to perform this task.

Your letter to me is very clear indeed. In response to your final paragraph I would simply say that when the Trust produces plans that address the health care needs of all of the populations of both City and Sandwell Hospitals in a fair and equitable manner, we will be able to campaign for the Trust and not against it. I look forward to that time.

Yours sincerely,



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

Ken and I would be very interested to here your opinion on these matters. The use of the comments facility below is positively encouraged.

Information or Propaganda?

I have just been reading the June copy of Heartbeat which is apparently the pulse of Sandwell, City and Rowley Regis Hospitals. The editorial team are certainly not short on hyperbole when it comes to reporting progress on Towards 2010 and the Interim Reconfiguration proposals. The story is only from one side, with no reference to opposition or indeed facts that inconveniently do not fit the party line.

Would staff have been interested in a few pertinent facts? I can think of a few examples: Such as how does the population affected by the Interim Reconfiguration relate to the population responding to the Shaping Hospital Services for the Future paper that sets out how services would change in the interim. Well only 15.6% of respondents were from the ethnic minorities, whereas the inpatient ethnic minority population at City from the Trust's own data on its website is running at 45.9%, a threefold difference! No comfort for the Trust here. The best way to have targeted these people would have been to consult them as patients on the wards, in outpatients, and in their general practitioner's surgeries. This did not happen.

Interpreters would have been needed and instead of talking about concentrating inpatient Children's services and Emergency Surgery services at Sandwell Hospital they should have explained that if they had needed to remain in hospital more than 24 hours they would face being moved by ambulance to Sandwell Hospital or elsewhere. I cannot visualise them lining up to say yes to that proposal!

How about one or two more consultation facts. When people were asked about whether they agreed with the proposed changes for surgery 47.2% said NO and 31.4% said YES. The NOs have it in spite of consulting the wrong population. Interestingly there were very similar figures for the proposed changes to children's services, 45.6% said NO and 29% said YES. Do you think it is just remotely possible that if they had consulted the right population even more would have said NO?

I looked very hard in Heartbeat to see if they had included a mention of the Birmingham City Council Health Scrutiny Committee decision on the Interim Reconfiguration plans, and the fact that the committee had referred the Emergency Surgery proposals to the Secretary of State and proposed that an Independent Reconfiguration Panel is convened. No that has not reached consciousness either, or if it has, it has been conveniently airbrushed away.

Heartbeat cannot claim to have the pulse of City Hospital until it accurately presents the facts whether they are palatable or unpalatable. I suspect an independently minded editorial team is needed. I would welcome the opportunity to write the front page for the July edition? Is anybody listening out there?

Finally I received another glossy brochure about Towards 2010. today. It presents an analysis of the public consultation, (I wonder how much this little lot has cost?) There were some additional papers entitled Public Consultation on the 2010 Proposals. There is a section "Service Transition" and it states and I quote "It has been a longstanding principle for the 2010 Partnership that the proposed new acute hospital needs to be almost the final element of the system to be put in place . This is based on the recognition that any other sequencing could mean that the new hospital was too small to cope with demand in the absence of the proposed community services."

Well what do you make of that? I am trying to get my mind around the timescales. Presumably the idea is that all the health centres, community facilities and community hospitals will be built and up and running by 2010 giving 3 years to build the new hospital so that it could be open by 2013??? Does this sound realistic? It sounds as if the money for the new hospital will be raised later, as you would not want to raise PFI money until you actually need to spend it. What happens if we cannot afford the last stage at all, or can only afford half a hospital??

Why not keep what we've got, ensure that the developments in the community go together with the new hospital build simultaneously, and work our socks off to achieve this as soon as possible?
I suspect people would feel that this a plan we could all get behind!

SWBH Plans Featured on The Politics Show

The Politics Show had a piece today about the controversial plans being considered at Sandwell & West Birmingham Hospitals NHS Trust. If you missed the program do not worry; you can watch the programme by clicking on this link and pressing the latest programme button on the right hand side (this should be available for the next week). The article starts 10 minutes 20 seconds in, although you may be interested in the piece on euthanasia which precedes it.

The programme started by interviewing an anonymous man who had been treated at City A&E for gunshot wounds, underlining the point that we are moving away emergency general & trauma surgery beds from an area with a high gun crime and stab wound incidence rate. When added to the fact mentioned by Councillor Deirdre Alden that when the General Hospital closed, Dudley Road Hospital was renamed City Hospital and we were told it would be the hospital for Birmingham City Centre, we have the main reasons why the interim reconfiguration proposals are so ridiculous. We reiterate again that we are not against the building of the new hospital and the investment outlined in Towards 2013/14 2010. We simply want to ensure that until the new hospital is built, and we have some proper plans for it instead of just spin and conjecture, services should remain at the same high quality they are now.

When Sue Davies, Trust Chair, responded to this point she said that Birmingham had three hospitals and so there was a choice where you can go. This completely misses the point. If you are being admitted for emergency surgery, you do not choose where you go. The Ambulance service takes you to the most appropriate local hospital. At the moment they can take you to City, which is roughly 10 minutes away from the City Centre. In future, they may decide to spend another 15 minutes taking you further down the road to Sandwell Hospital, or more likely take you to Heartlands or University Hospital. Either way, whether you are the victim of gun crime in Winson Green or have an accident in Birmingham City Centre, it will take the Ambulance longer to get you there.

Hugh Bradby, the medical director at SWBH, again used the argument that one is better off travelling further away to the best services rather than being treated locally in poorer facilities!!!! I have pointed out on this blog before in a previous post that I believe this statement is misleading. Currently we have acceptable facilities at both sites to manage emergency surgical and paediatric patients. It is the Trust that want to reduce these facilities at City and concentrate them at Sandwell, so the choice is really between being able to keep the patient at the same site where everything can be done or then having to move them to a new site after an arbitrary period of time.

Another quote, this time from the programme was by Marie Welch, a mother of four who has two children with special needs. In response to the replacement of emergency paediatric beds with a 24 hour PAU at City she said to the Trust:

"If you lived my life, walked in my shoes you wouldn't do what you're doing. It would stay."

Sue Davies' response to this was that more and more children are now being treated in the community rather than in hospital beds. However, there is currently a shortage of paediatric beds in Birmingham which will be made worse by these proposals. We already see children being transferred to hospitals outside the City due to paediatric beds being at full capacity.

I must be honest that I felt a bit sorry for Sue Davies. The lady did not look comfortable defending the indefensible.

The presenter finished by pointing out that there is another Dr Taylor in the region who is an MP as a result of plans to change the local hospital services. Would Ken consider running for MP, he asked? Dr Ken Taylor replied that he was ruling nothing out!

I guess we will have to see what the outcome is of the referral of the surgical plans to the Secretary of State and the overall proposals to the Commission for Racial Equality.