Final Report Recommends Downgrading Lewisham’s A&E

Well there’s a f*cking surprise: the final report from the administrator (TSA) of the bust South London Health Trust (SLHT) is out. Following consultation on the proposals to break up the trust, the most controversial of which was to downgrade Lewisham’s A&E and maternity services (despite Lewisham not being connected to the SLHT), the recommendation is still to downgrade Lewisham’s A&E and maternity services. Didn’t this already happen in West London?

There has been outcry in south east London over the plans. Thousands turned out in pouring rain to protest and more than 8,000 people responded to the consultation – of those who answered the question on Lewisham, 90% were against (PDF). Lewisham GPs are opposed (despite p.31 of the report headlining the relevant section “The changes have support from GP commissioners”; this could be because for any reconfiguration to go ahead, GPs must be in favour. One of the many appendices says “it would not be appropriate to give undue weight to any particular locality”. In other words, suck it up Lewisham). A consultant at Lewisham calls the plans “a travesty“. There are also major concerns about the impact on hospitals outside those covered by the report: the TSA assumes Lewisham residents will go to Queen Elizabeth A&E in Woolwich. In reality, because of the way public transport works, they’re more likely to head to King’s College in Denmark Hill.

Many of these concerns appear to have been ignored, though £37m has been allocated to expand A&E services elsewhere. We don’t want to get all tinfoil-hat about this, but we’d like to draw your attention to something said by a panel member at one of the consultation meetings, that the decision to close Lewisham had already been made.

It’s not just Lewisham A&E: maternity services at the hospital will be downgraded to a midwife-led unit, meaning certain high-risk births can’t take place there and any labour that develops complications will need blue-lighting elsewhere. Queen Mary’s at Sidcup will have no inpatient surgery. And then Greenwich Council (PDF) poured cold water on the underlying point of whole plan, the finances:

we are concerned at the suggestion that the proposed efficiencies to be realised are based upon the highest  performing Trusts elsewhere in the country. No information is provided to enable us to understand the demographic of the populations of those Trusts. We are also not clear as to what the Trusts in the benchmarking group provide in terms of clinical provision, such as the balance of A&E services, elective surgery etc. These seem to us to be key questions in ascertaining whether the efficiency targets are achievable.

Health Minister Jeremy Hunt has to make a decision on the report by 1 February. Labour’s shadow health secretary Andy Burnham has been pointing out that the TSA’s remit didn’t cover Lewisham and that Hunt shouldn’t approve the plans. If you want to make your voice heard, there’s another demo planned for 26 January.

Update: Ross Lydall notes in the Evening Standard that Jeremy Hunt has asked for legal advice about whether the administrator exceeded his remit, and on Twitter that the plans would cost £665.8m to implement – sparked by £207m of debt.

Photo by Andy Worthington from the Londonist Flickr pool

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