A Difficult Year for City Hospital

As we enter the last month of 2008 it is worth reflecting on where City Hospital stands.
Internationally and nationally there have been seismic changes in the economic and financial situation. The very foundations of capitalism have been shaken to the core. The nation, heavily in debt, is being exhorted by the government to spend its way out of recession as people struggle to pay their bills. Get yourself more in debt to save the nation seems to be the plan.

Is this going to make building a new hospital easier or more difficult? The government at one time talked about trying to avoid unemployment by proceeding with more public building projects. However all public building projects costing more than £1 million have to be funded by the Private Finance Initiative. I may have missed it, but I do not think PFI, surely one of the greatest follies of both Tory and New Labour governments has been suspended temporarily or permanently. Therefore the Sandwell and West Birmingham Hospitals NHS Trust needs a commercial enterprise to loan them the £350-400 million required so that they can waste taxpayers money paying 6% interest to fat cats. How likely is this to happen in the present climate as many of the fat cats have gone to ground? The Strategic Health Authority has asked the Trust to delay the new build once this year so that the putative date is now 2015. However after what has happened recently that date seems overly unrealistic. There is of course outline planning permission from Sandwell Council for what it's worth.

The construction of a 24 hour Surgical Assessment Unit by refurbishing a ward is under way at City Hospital, and when it is complete we will see acutely ill surgical patients needing longer than 24 hours in hospital bundled off to Sandwell. It is clear that this is no short term arrangement. The local people will have to live with it for a long time. Meanwhile we still wait patiently for the Equality Commission to say something meaningful about the question they were asked by City Hospital Supporters back in the Spring of 2007. Perhaps somebody can explain to me the point of having an organisation with an impressive name like the Equality Commission? When asked to adjudicate on an important question of racial equality affecting the lives of many people it takes 18 months and appears to have got precisely nowhere. The matter has been passed on to some other individual. The workings of this organisation as far as City Hospital Supporters are concerned have been totally opaque. I fear the only conclusion to be drawn is that England has an Equality Commission so that we can say we have one. The box has been ticked, but in reality nothing is being done, at least for the citizens of West Birmingham.

The Sandwell and West Birmingham Hospitals NHS Trust has a very important campaign running at the moment. It is called "Listening into Action." I think I can hear your hollow laughter. I believe management consultants have been involved with this exercise and now every member of staff has been sent a DVD on the subject which apparently only cost 40p per person! The thrust of Listening into Action is that managers should take note of what front line staff are saying and incorporate their ideas into management decisions. This was applied to a ward and apparently it made a big difference. Gosh isn't that truly amazing! Perhaps a Nobel Prize for management is in the offing. It would not surprise me in the upside down world that is England in 2008. Any manager worth his/her salt knows that it is essential to listen to the people working at the coal face and the customers.

What a pity the Trust were not prepared to implement Listening into Action over their consultation questionnaires for the Interim Reconfiguration. Local people rejected their plans resoundingly as did the consultant medical staff at City, but the only action that followed was implementation of the plans regardless of the views expressed.

Interestingly some planning towards the new hospital has been taking place but Listening into Action has not been applied to consultant medical staff once again. Apparently there will be no room for offices for consultants if and when the new hospital is built. This is another stupid short-sighted decision. The consultant medical staff of a hospital are fundamental to its success. You need to attract the best calibre candidates to look after the local population. You need to encourage doctors to stay on site and be available to support junior and nursing staff. They need somewhere to have one to one meetings in private. They need somewhere to hang a coat and a desk to sit at. Somewhere to work on case notes, referrals and all the activities that go with being a consultant. No office sends the message to them that they are not valued and their role is not understood. It will encourage them to leave the premises as soon as they have completed their contracted hours. I would suggest that if accomodation is tight because the new build is on a shoestring, they should make managers not involved directly in providing or supporting clinical care redundant, especially those on the higher payscales. This would save valuable revenue for more important activities and free up offices for consultants.

Talking about saving revenue I note that the Trust's Communications Team or should that read Propaganda Team consists of ten individuals plus a chief! Wow big bucks there, it must be costing a fortune and think of all those offices. If we had fewer propagandists could we afford more nurses? Now that would be putting Action into Listening!!

And so another year draws to its close. What is in store for the NHS? In one word AUSTERITY. Literally millions and probably billions of pounds have been wasted pouring money into an NHS fundamentally badly managed. It is not in good shape to withstand the cold wind of the new economic climate we are now facing.

The number of emergency medical admission at City continues to rise inexorably. The Accident and Emergency Department is doing a fantastic job under enormous pressure. In my PERSONAL view the best Christmas present for the people of West Birmingham and Smethwick would be a sudden change of tack, with agreement to build a new hospital on the existing Dudley Road site. Sandwell Hospital would be welcome to join in.

I do not believe this would delay the new hospital because I do not believe the present plan is viable. Is it possible for us to see a change of plan? Anything is possible. Maybe a change of government would help. Undoubtedly City Hospital Supporters need to start making their views known in no uncertain terms.

Happy Christmas to you all. Ken Taylor

The Latest Propaganda on TOWARDS 2010

I have been looking at the publication "Towards 2010" circulated to all staff by the SWBH Trust. On the front page it says that "local NHS staff believe care should be provided as close to home as possible." I think they must be talking about local health care managers who are doing as they are bid by government. I have not met many NHS medical or nursing staff who believe this to be true. I have not met many patients who believe this to be true either.

Apparently "we (the Trust in partnership with the Heart of Birmingham PCT, Sandwell Council and Birmingham Council) will help people to stay healthy, stop smoking and adopt healthier lifestyles." It sounds miraculous, it sounds too good to be true. Indeed if you examine the evidence for achieving these goals in the long-term others have failed where our crusaders hope to succeed.

There will be new larger health centres. GPs will be brought together into larger health centres offering a wider range of services with social care and other community services.

What do the existing local GPs think of these plans? Have they been consulted? What does the Birmingham Local Medical Committe think? Having spoken to a key person in that organisation the answer is--not a lot.

There are to be Community Diagnostic Services delivered from Community Hospitals so that most people could have tests done without travelling to a specialist hospital. It sounds nice, so convenient. However any sensible person must realise that for every advantage in this life there is a disadvantage. The more diagnostic services that you have divided up in different places the higher the cost. This may mean that the state-of-the-art specialist hospital has a distinctly less state-of-the-art X-ray Department than it should have.

There is to be more active involvement with people who have a long-term health condition to help them maintain independence, using telecare and rapid response teams to deal with crises locally. What can this mean? Does it make sense? Can anybody tell me what contribution telecare is going to have? Perhaps it means that fragile immobile people will have cameras in their homes so that when they collapse or fall over somebody watching the big screen can report it to somebody? This country already has more cameras watching every aspect of life from speeding to walking down the street and possibly in the future you will not be able to be seriously ill in private.

What about outpatients? This is very simple. Most outpatient appointments and specialist consultations will be provided in local communities. Why? Have the patients asked for it? NO. Will it provide better care? No evidence to support that contention. Will it train the doctors of tomorrow better? Definitely not. Will it destroy consultant led care as we have known it in the UK. It sure will.

Latest techniques. It says that they will use the latest techniques to ensure people recover quickly and need to spend less time in hospital. Are we using the latest PROVEN techniques now to get people better quickly? You bet, all doctors want their patients to get better as quickly as possible not to cut the number of beds, not to save money although that is important but first and foremost because it is good for patients.

Intermediate care. Where is that going to be provided? Oh yes in the community along with everything else. Who will medically supervise all this community care. Will it be the GPs? Will it be the Consultants? This is an important issue. The old community hospitals were a complete disaster. Mostly they were primary care beds. Patients tended to get neglected and overlooked and were often admitted to hospital to have things properly sorted out.

On the front page of this paper there are eight headings before we reach the last one about the new hospital. Does that tell you anything?

What will happen to the City Hospital site? The Birmingham Treatment Centre will carry on as normal. The Birmingham and Midland Eye Centre building will form the core of the new community hospital. The Sheldon Block may also be kept as part of that new facility. The rest of the site will be sold for redevelopment. Birmingham will lose the enormous expertise concentrated in the present Birmingham Eye Hospital, what a waste, what bad news for the people of Birmingham.

It has to be complete madness to give up prime NHS land in a prime very convenient site for the people of West Birmingham to have their hospital only to go and buy more land a mile down the road to build another hospital. Where is the sense? Especially as inpatient Children's services and inpatient Emergency Surgical beds are being lost years ahead of any new hospital.

There has to be very serious doubts about whether the new hospital will ever happen. All we have at the moment is an aspiration and a lot of very hot air.

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.

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?

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?

YOU KNOW IT MAKES SENSE!!!!

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!)

ANOTHER REMINDER.

CITY HOSPITAL SUPPORTERS GROUP MEETING TUESDAY 4TH SEPTEMBER 12.30PM ANNE GIBSON ROOM CITY HOSPITAL.

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.

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.

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.

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.

Fears About Confidentiality of the Ballot

As the ballot of senior medical staff reaches its final day tomorrow I have been talking to colleagues and urging them to vote. The ballot closes at 5pm so if you have not voted take your envelope to the Postgraduate Centre in person please.

There clearly are concerns about confidentiality. I must emphasise that the ballot papers must be numbered so we can prove to the independent referee that nobody has voted twice. We can tell who has voted but assuming everybody puts their ballot papers in sealed envelopes with numbers on the outside we simply tick off the list that they have voted and do not open the envelopes.

The count will be held at the Afro-Caribbean Millennium Centre on Thursday 21st June at 11am. The independent referee is Mr. Darren Wright the Principal Officer of Birmingham City Council Health Scrutiny Committee. The Trust have been invited to send a representative but they have declined. The list of names will be sealed away before the envelopes are opened and I will store them safely just in case an independent review were demanded. I would ensure that no member of Trust management ever had sight of these lists.

Trust Board Decide to Engage Consultants

Ken Taylor's ballot of the Consultants at City regarding the interim reconfiguration plans really seems to have got the wind up the Trust board. The following letter went out to all consultants on the 13th June 2007 (click here for original copy).

Sandwell & West Birmingham Hospitals NHS
NHS Trust

Chief Executive
': 0121 507 4847
Fax: 0121 507 5636
Email: john.adler@swbh.nhs.uk


To: All SWBH Consultants
cc: Executive Team, DGMs


13 June 2007


Dear Colleague

Shaping Hospital Services for the Future

Those of you based at City Hospital may have received a letter from Ken Taylor proposing a ballot of City consultants on the Trust’s plans for service configuration change in advance of the “Towards 2010” plans for a new hospital. In the light of this I am writing to remind all consultants whether based at City or Sandwell where we are in the process with these important plans.

Our plans for change in pathology, paediatrics, neo-natal care and surgery have been developed over the last 18 months following extensive discussion with clinicians from the services involved. As this work has proceeded there have also been many opportunities for the wider clinical body to contribute to the discussion which many of you have taken. Finally, as you will be aware, we carried out a four month formal public consultation on the plans that concluded in mid-March 2007.

As a result of ongoing work with clinicians and in the light of the outcome of the consultation the final proposals recommended to the Trust Board incorporated a number of important changes:

· the Paediatric Assessment Unit at City Hospital will be open for 24 hours a day;

· there will be a 24 hour Surgical Assessment Unit at City to increase support for A&E and reduce the numbers of patients needing transfer to Sandwell;

· elective colorectal surgery will be retained on both sites to ensure there is support for gynae-oncology at City Hospital.

The Trust Board approved the plans for change at its meeting in May. The Birmingham local authority scrutiny committee referred the proposals for emergency surgery only to the Secretary of State and we are waiting for confirmation of the next steps in this process. The rest of our proposals were not referred and can therefore proceed. The ballot that Dr Taylor is seeking to organise does not have any formal status as part of the Trust’s decision making on these plans.

For those of you who have received Dr Taylor’s letter, there are two particular points that I would like to stress.

Firstly, the Trust has strong support for the plans for a new hospital and is moving rapidly in developing these further. In addition to longstanding support from our PCTs, and public support shown through the consultation, we have also recently had renewed confirmation of SHA and DoH support for the programme at their latest review of the plans. I am also pleased to be able to tell you that the Trust Board approved the business case for the purchase of the land on which the new hospital is to be built at its meeting last week. This business case will now go to the SHA for their approval. Work on the detail of the plans for the new hospital is also well underway as part of the process of preparing the hospital outline business case for submission in March 2008.

Secondly, the steering groups and the executive team carefully considered the range of possible options for change in both paediatrics and neo-natal care and in surgery before deciding to proceed with these plans. We are clear that we have identified the best options available to us. The plans for a single paediatric inpatient unit at Sandwell have been developed alongside the plans for developing the neo-natal unit at City and taken together include significant capital and revenue investment in these services. The plans for emergency surgery were developed alongside plans for bringing elective surgical services together and are designed to make the best use of the theatre capacity available to us at each of our sites. We believe that the proposals approved by the Board provide the best way forward for our services and now want to focus on planning for implementation so that we can get on with developing our services for the future.

The proposition on the ballot is essentially for the status quo. It is of course entirely up to each consultant whether you wish to participate in the ballot at all and if you do, which way to vote. I trust, however, that this letter has helped ensure that you remain up to date with our progress on these plans and are presented with a full and accurate statement of the position. As always throughout this process, if you have any questions or wish to discuss further please do not hesitate to contact me,

With best wishes.

Yours sincerely,

John Adler
Chief Executive


Isn't it amazing what it takes for a Trust Board to engage its consultants?
*******************************
I am going to respond to some points in John Adler's letter:

In his second paragraph the Chief Exec. talks about extensive discussion with clinicians from the services involved. He is presumably referring to the Sandwell-based Medical Director and Sandwell-based Clinical Directors in Paediatrics and Sandwell-based surgeons? I have been getting a very different message from the City-based clinicians. At no time has the Trust balloted the senior medical staff at City on their proposals.

The consultation was fundamentally flawed. It did not address the multi-ethnic population served by City Hospital. It did not tell the community that if they had an ill child or a surgically ill adult although they would be assessed at City Hospital, if they needed to stay in hospital longer than 24 hours they would need to be moved by ambulance to Sandwell Hospital. This would be the only population in Birmingham subject to this inferior form of care, and it would not be suffered by people going to Sandwell Hospital with the same problems. Are these plans really tenable expressed in this way?

However in spite of consulting the wrong population and not providing them with the full facts, the proposals were still resoundingly rejected.

The Chief Exec. omits to mention that the Commission for Racial Equality are now involved in the reconfiguration plans.

How the Executive Team have concluded that they have the best options for Paediatrics and Emergency Surgery is a complete mystery. The best options for whom? Not for the poor people of West Birmingham. Not for City Hospital.
I think it means the Trust has a very different agenda. and the sooner we understand what that agenda is the better.

There has to be a very real concern after what has happened in Coventry with the Walsgrave PFI. The local health economy is going to have to find many millions of pounds and there will be severe cutbacks at the hospital. One has to ask the question well what about the new University Trust PFI here in Birmingham? It is a bigger project than Walsgrave. How will that black hole be financed? Could it be at the expense of City Hospital and the population it serves? What chance of another big PFI happening in the near future in the Birmingham area? Can anybody answer these questions please? Would it not be sensible to maintain the status quo at City Hospital until that new PFI happens as the Executive Team try to assure us it will?

Ken Taylor. Posted 00.15hrs 19th June.

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!

Medical Director Misleading Everyone?

When Dr Hugh Bradby was being interviewed on The Politics Show on Sunday 3rd June I believe that he misled the viewers. The piece opened with a brief interview with a gunshot victim that had been successfully treated at City Hospital. The patient made the point that City Hospital had saved his life. It moved on to a view of the A&E Department at City as the commentator said the management wanted to move the main Emergency Surgery Service to Sandwell Hospital while establishing a 24 Hour Surgical Assessment Unit and management maintain that this is an improvement. They then cut to Dr. Bradby being interviewed at Sandwell. He said "I would want treating where the best facilities were and all the evidence shows that you are far better off travelling further away to the best resourced department than you are to a local department that perhaps does not provide you with as good a service."

This is an outrageously misleading statement. What better resourced department is he talking about? Is he talking about the A&E Department at Sandwell? He cannot be because the patients referred to would be sorted out in City Hospital's A&E Department and the 24Hour Surgical Assessment Unit. If the plans go through they would then move to a ward bed at Sandwell if they needed longer than 24 hours in hospital. Currently patients are admitted to a bed at City. Is he telling us that Sandwell Hospital has better wards, more and better nurses, more and better doctors, less infection on the wards than City Hospital? If he is where is the evidence?

In fact patients moved to Sandwell Hospital will receive similar care to that delivered at City but they will have suffered the risks and inconvenience of an additional ambulance journey with all the attendant problems for their relatives. This extra journey would be occurring because the Trust has decided to make changes to emergency services that are not in the best interests of patients. This will not be better care but worse care that is why City Hospital Supporters are so opposed to it.