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

A Worrying State of Affairs.

The wheels of British justice turn exceedingly slowly. City Hospital Supporters made a formal complaint to the Commission for Racial Equality in the first half of last year. In essence this pointed out that the City Hospital population had three times the Black and Asian Ethnic Minorities as inpatients compared to Sandwell Hospital using the Trust's own data.

It is the City Hospital patients (Children and Emergency Surgical cases) that will receive less safe, higher risk care with more travelling inconvenience for their families and friends as a result of the Trust's Interim Reconfiguration proposals. We believe this constitutes discrimination. Interestingly City Hospital Supporters are not aware that there were any members of the Black and Asian Ethnic Minorities on the Trust Board as non-executive Directors prior to its decion to proceed with its plans in May last year. Subsequently some members of the ethnic minorities have joined the Board.

The Trust should have done an Impact Assessment of its proposals to determine exactly how the ethnic minorities would be disadvantaged BEFORE it went out to consultation and certainly before deciding to proceed with its plans. An Impact Assessment after implementation is hardly treating the minorities with the respect they deserve.

City Hospital Supporters urged the Commission for Racial equality to speed up their investigation. However in the autumn of last year the CRE underwent a transformation to become the Equality and Human Rights Commission. This change delayed all the cases under consideration. However a recent letter from a Senior Legal Officer at the Commission indicates that they are definitely on the case.

The "Independent"? Reconfiguration Panel were made aware by City Hospital Supporters that a referral on the grounds of racial discrimination had been made. They chose to ignore this completely. It is noteworthy that there were no members of the Black and Asian Ethnic Minorities on the group of four members of the IRP who attended Birmingham.

The Secretary of State for Health also chose to ignore the fact that the EHRC were actively considering the case when he endorsed the IRP'S decision to allow the Trust to proceed with its reconfiguration plans.

Now all this is very worrying as far as democratic ethical government goes. Why have a body with a grandiose name such as the Equality and Human Rights Commission if government and their representatives can carry on with their activities without even waiting to see the outcome?

Lastly it has recently been reported that the Sandwell and West Birmingham Trust has been asked to delay proceeding with the new hospital. I wonder how often we will hear that refrain? The ink has hardly had time to dry on the great plans for a new hospital, and already the date for it to open its doors is being pushed further into the future. No wonder City Hospital Supporters have serious doubts it will actually be built at all.

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.

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.