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The Lewisham experience - coming to a CCG near you?

The announcement of a hospital closure creates a highly emotive, visceral reaction. As commissioners we realise not every hospital can be sustained and there are hard choices ahead.

But the experience in Lewisham is a sad day for commissioning as well as for patients because of the rushed process and disregard for local commissioners. It’s as if commissioning for our population did not exist.

The decision is fundamentally flawed for several reasons

1/ Lewisham should not have been included

South London Health Care Trust (SLHCT) was a merger, about four years ago, of three failing trusts into one large failing trust. Since then, it has improved clinically, but remains crippled by a huge PFI dept and, according to the Special Administrator, continuing managerial failings.

Andrew Lansley invoked the regime that had been created by Labour for unsustainable trust failure and appointed a Trust Special Administrator(TSA) to sort the trust out.

Mr Kershaw immediately included our local hospital, Lewisham, even though we are not part of SLHCT, in his brief and proceeded to recommend downgrading our A&E to an unsustainable urgent care centre, cutting ICU, downgrading maternity and paediatrics and effectively gutting the hospital. However, he suggested that Lewisham become an elective centre for SE London and that it take over one third of the SLHCT.

Health secretary Jeremy Hunt, agreed to all the TSA recommendations, although an admitting A&E for non-serious cases has been recommended – but no ICU to back it up.

Lewisham council has begun a judicial review which challenges the TSA’s right to include Lewisham. In addition, it is clear from figures derived from the TSA report that the financial outcomes desired do not require reduction of services at Lewisham Hospital.

2/ The changes will result in poorer services for the population of Lewisham

The evidence is strong that Lewisham hospital is performing well.  Our submission to the TSA has shown the risks of:

-delayed transfer of patients to A&Es elsewhere

- inadequate maternity provision with no consultant back-up

- decimated paediatric services

- inadequate responses to acute mental health problems issues without a full A&E

- poorly resourced services in neighbouring hospitals despite investment.

- flawed assumptions in the TSA arguments about numbers of patients who would be served by the urgent care centre resulting in inaccurate predications for the system as a whole.

3/ Patients and the CCG were not involved in the decision

Lewisham CCG is totally opposed to these changes.  The CCG is clear that the changes threaten care for the local populations, fragment long-standing relationships that facilitate planning continued improvements in care and will not result in a reduction of 30% of admissions on which the plan is predicated
The consultation time and process was quite inadequate. The LINk has told us that people found the documents difficult to complete because they were difficult to understand and asked leading and unfair questions.  Clinicians do not feel that were listened to – there is strong testimony that they were actively ignored.  The LINk talked to hundreds of people and groups – we estimate that over 90% of people in Lewisham are against the proposals.  .

This is not commissioning. It is a process whereby thriving hospitals are having to save failing ones – this is not a good way to run a service.

This process is designed to pay back the bankers who hold the PFI debts, not to find ways of designing better services for patients.

This process is given urgency and pace because we have designed a quasi-market which does not work, is not needed, is expensive and for which there is almost no evidence.

So while you may think your hospital is doing OK, be warned: a hospital’s poor finances several miles away could pull the rug right out from under your commissioning feet.

By Brian Fisher is a GP in Lewisham, member of Lewisham CCG and is involved with the Campaign to Save Lewisham Hospital

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