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Last Saturday I was driven round Lewisham in a council refuse truck decorated with balloons and Justice for Lewisham posters, megaphone in hand, announcing the wonderful news that we had won our judicial review – the decision to close Lewisham’s emergency medicine and maternity units had been quashed.
The Save Lewisham Hospital campaign and Lewisham Council had taken health secretary Jeremy Hunt to court to challenge the decision – taken on the recommendation of the TSA (trust special administrator) - and won!
This was the culmination of 10 months of campaigning involving every section of our community, bringing doctors, nurses, patients, public, CCG (clinical commissioning group) and council together in a powerful movement.
It began last autumn when we found out that the TSA, appointed to solve the financial problems of South London Healthcare Trust – a completely separate trust in financial meltdown because of unpayable PFI (private finance initiative) debts. – had decided to look beyond the South London Healthcare NHS Trust (SLHC) and propose service closures at Lewisham.
The judge declared the decision unlawful: both because it was ultra vires – outside the health secretary’s powers – and also because there was no support from the local CCG.
We hope this means the government cannot in future use the TSA regime to fast track closures in trusts outside the one to which he was appointed.
The case highlights the issue of PFI. PFI repayments amount to more than 1 per cent of NHS spend. As the repayments take an ever increasing share of PFI hospitals’ budgets they threaten the survival of non-PFI hospitals in their area.
No matter how much the latter are needed by their community, how well run or solvent as Lewisham Hospital is – they are vulnerable to closure. Whipps Cross, for example, could be closed to bail out Barts’ PFI. Our successful judicial review won’t help such hospitals as they are in the same trust. We must campaign for a solution to PFI - for example to share the debt across the NHS, renegotiate or annul the contracts.
The case shows the centrality of the CCG. Our CCG did not support the closure as it recognised the harm not only to patient care but also to its plans for innovative patient care in Lewisham. The government, having reiterated that configurations needed local commissioners’ support, tried to argue the opposite in this case – and rightly lost.
We have shown what can be achieved when doctors join forces across professional boundaries and work with people in the community. The medics made a fantastic contribution to the debate – taking the TSA proposals to pieces in masterly critiques, which are all on the campaign website.
They show that this was never about improving patient care. I think the TSA started from where he wanted to be – close Lewisham to help pay SLHC trusts debts – and worked backwards from there using paper-thin clinical justifications that don’t stand proper scrutiny.
The government plans to appeal – in the words of one of the hospital consultants involved in the campaign: ‘Bring it on!’
Emergency department closures in London will be debated at the BMA London regional council’s annual meeting on September 17 in BMA House. I will be speaking – come and find out more about Lewisham’s remarkable story.
Louise Irvine is a GP in Lewisham, chair of Save Lewisham Hospital campaign and a member of BMA council and the BMA GPs committee
The Save Lewisham Hospital campaign website
The Special Administrator of SLHT made it clear in his report to the Secretary of State that he recommended the writing-off of the Trust's PFI debt - so Dr Irvine's assertion that the inclusion of Lewisham in a further reconfiguration to bail out SLHT is not true. She will know that Lewisham was originally part of the reconfiguration but decided to "go it alone". If Lewisham has now been "saved" then there may be catastrophe for the rest of SE London; from a clinical point of view, holding on to two A&E departments so geographically close as Lewisham and the Queen Elizabeth at Woolwich makes no sense. The SA had every reason to look not just at SLHT but at the surrounding healthcare milieu; none of the parts can be considered in isolation as inviolate units.
Perhaps Dr Irvine should ponder whether her campaign has been selfish in considering the good of Lewisham while likely to cause havoc in the wider SE London area. Alternatively perhaps the government should consider whether financial pressure should remain the prime mover in NHS change. I write as an ex-consultant at Queen Mary's Hospital, Sidcup, whose A&E and maternity services were ripped out by the original creation of SLHT, but whose future in any shape or form is now zero
well done Dr Irvine. why should Lewisham be scapegoated for the sake of another trust. I hope this is the beginning of real resistance to this government's agenda of bringing the NHS down to its knees
I wished we had more people like you at the BMA
This is a disatrous outcome for General Practice and Primary care throughout the UK and sounds the death knell foe the NHS.
This isn't a victory. Just a judge ruling on a point of law. If appeal doesn't succeed the law will be amended.
In the meantime hospital and CCG in debt and services failing.
HIMBYism (hospital in my back yard) doesn't improve care or outcomes.
Perhaps Andrew should have fought as hard as Louise to keep his maternity unit; just saying. Easy to sit back and take hits; harder to stand up and voice concerns. If all areas did this, do u not think DOH would find money from some slush fund or other areas where they waste money
The TSA report does not recommend "writing off the Trust's PFI debt". If Dr Bamrah can show us where it says that it would be interesting. There is a suggestion that there be a PFI debt subsidy for three years. But there are still another 20 years or so to pay. It is clear that the reason that the SLHC Trust was "unsustainable" was in large part due to PFI debt. Greenwich and Princess Royal cost about Â£230 million to rebuild. About Â£600 has already been paid and Â£2 billion is still owed of which 60% is interest payments and 40% is for building maintenance. The debt rises with RPI while the hospitals' income is falling due to tarriff changes etc. PFI has first draw on any resources and what is left is for patient services. Even if hospitals were closed the PFI would still have to be paid. The PFI is a running sore - the previous attempt to sort this out by closing Queen Mary's Sidcup (non PFI therefore vulnerable) failed. Roy Lilley's suggestion that the PFI debt be spread across the NHS is a good one, but better still we should pass legislation to annul them - the PFI companies ( all now based in offshore tax havens and paying no UK tax) have had enough of our money - they should not be given any more.
(Apologies for getting Dr Bamji's name wrong in last comment - typing too quickly!)
Dr Bamji says that Lewisham and QE are very close to each other and one could therefore close with little adverse impact. QE hospital is about 10 miles from Lewisham hospital and even further from many areas of Lewisham, with poor transport links. Our website shows two separate patient journeys filmed and timed that each took nearly two hours for people to get from Lewisham to QE by bus. These were real journeys. The TSA report gave ambulance times from Lewisham to QE when there is no traffic - anyone who has been on the south circular knows its choc-a-bloc most times of day. Ambulances are amazing but they don't turn into batmobiles and actually fly over dense traffic. Of the 5 hospitals in the SE with EDs, two were powerful FTs, two were debt ridden PFIs and so that just left Lewisham as an object for closure. This is about politics, expediency and money - not about patient care. To accuse those who want to defend vital local services as being "reverse NIMBY" is to ignore the needs of nearly 300,000 people in one of the most deprived boroughs in England. No good clinical case has been made for this and once again I urge people to go on the website www.savelewishamhospital.com and actually read the contributions of clinicians - hospital docs, GPs and public health - who made detailed critiques of TSA plans from the point of view of patient care - none of which were adequately answered by TSA. In particular local GPs and CCG were opposed precisely because they believed it would be damaging for patient care and for CCG plans to lose the hospital with which they were collaborating to develop new community based patient care pathways.
I cant believe the sectional interest and limited understanding or sectional interest portrayed by Andrew Bamji - and clearly Mark S, James Goodman agree with him.
The demise of QMH Sidcup has meant a reduction in care for the population of Bexley and a knock on deterioration in care for people using QEH Woolwich and PRU Orpington/Farnborough. Where was Dr Bamji in campaigning for better health care for the local population? And yet again, the TSA has finally destroyed hospital-based care in Bexley, with virtually no opposition from the local clinicians - with notable exceptions.
The Lewisham campaign was fighting to preserve essential capacity in an are of 1.65 million people, rather than lose without any planning over 400 hospital beds. We have fought and won this round NOT JUST for Lewisham Hospital, but for the communities of both Lewisham AND Greenwich who were facing the loss of yet another major hospital in a highly deprived inner-city population.
We do have to answer the questions put to us. But there are answers, and further questions. Millions of pounds wasted on unlawful processes by the TSA/Secretary of State, Â£100s of millions of pounds on consultancies like McKinsey - do you support such wasteful hopeless expenditure? - and billions of pounds haemorrhaing out of the NHS to service PFI contracts.
Our job is to say, working with the CCGs and local authorities and communities, let us insist on safe care primarily; work towards community care where appropriate, but knowing that there is no definite evidence that good community care is cheaper (see recent BMJ editorial); dentralise services that are appropriate such as stroke, but insist on high quality local DGH care with GPs for the vast majority of acute pathways not least of which is care of the acutely ill elderly.
Be honest, do you want a National Health Service or not?
Truly, it is far easier to tear down the achievments of others than to build your own. The Save Lewisham Hospital campaign was never really solely about Lewisham; it was about the 'illegal' use of the TSA regime to reconfigure services in an NHS Trust NOT covered by the remit of the Unsustainable Providers Regime. It was about preventing the misuse of the TSA regime to reconfigure services purely on financial and ideological grounds with scant consideration given to the clinical consequences (which the Govt would be obliged to explore and evaluate under the SoS's existing powers).
For fantasy historians such as Mark S; Lewisham is NOT in debt, nor are its services failing. Even the TSA didn't try to make such an assertion; I suggest you try to ground your comments at least partly in fact. Thankfully James Goodman doesn't even pretend to provide any evidence in his statement about the impact on GPs and Primary Care nationally. I recommend to both Mark S and James Goodman the FACT-BASED submissions made by clinicians to the TSA that can be found on the Save Lewisham Hospital campaign website.
As a former Registrar at QMH Sidcup and present Consultant at Lewisham, I am constantly struck by the difference in the reaction to a potential downgrade between the two sets of hospital staff/ local GPs and surrounding populace.
Dr Bamji may well feel bitter as to the final outcome for QMH, but where were the marches by 25,000 people that he helped to organise? Where was the unanimous support from local hospital and community doctors? The whole-hearted vocal and financial support from the local government as well as MPs of ALL political hues? Lewisham's campaign was intelligently thought out, well-run and enthusiastically supported. It's victory provides succour to NHS Trusts and services nationally, vulnerable to Government cuts because of PFI debts in unrelated organisations.
By all means, we all welcome joined-up thinking in the NHS, but for such a debate to succeed it will require the Government/SoS to both listen to the rest of us and respect our views.
Fighting for our local NHS - since when is that a bad thing? Especially since the TSA's proposals are so unjust. Does Dr Bamji seriously expect that the residents and doctors of Lewisham should simply accept that their solvent, successful hospital should be closed as a sacrifice to divert money towards their debt-ridden neighbour?
Live by the sword, die by the sword, surely? If the government wants to run the NHS as a series of financially quasi-autonomous, competing trusts then they can't buck the market by using a financially solvent neighbouring trust to bail out one that's failing. That's not me being narrow-minded in my own silo (as a Lewisham GP), it's the consequence of the market philosophy -- imagine if M&S had been plundered to bail out Woolworths! If the government can't face having a trust fail (which, of course, underlines the inappropriateness of the whole philosophy) then it should abandon its market experiment. The TSA proposal was illegal, pure and simple.
Well done to all who resisted the TSA's conclusions. It is heartening to know that we have doctors such as Louise who will take on vested interests
I am concerned that if the government appeals this decision, whos money do they use when taking it back to the 'courts' The 'fight' by UHL was done by fundraising in the community'.Me thinks' that the tax payers money will be used ie Lewisham folk including me! Sorry Mr Hunt you have lost give up and leave us alone. As you probably have not been to see our area lately you might notice that we have a massive amount of new housing in which people live! We need our A&E and our maternity more now than ever. Well done to Dr Irvine and all her colleagues who never gave up.
Truly, it is far easier to tear down the achievements of others than to build your own. The Save Lewisham Hospital campaign was never really solely about Lewisham; it was about the 'illegal' use of the TSA regime to reconfigure services in an NHS Trust NOT covered by the remit of the Unsustainable Providers Regime. It was about preventing the misuse of the TSA regime to reconfigure services purely on financial and ideological grounds with scant consideration given to the clinical consequences (which the Govt would be obliged to explore and evaluate under the SoS's existing powers).
Dr Bamji may well feel bitter as to the final outcome for QMH, but where were the marches by 25,000 people that he helped to organise? Where was the unanimous support from local hospital and community doctors? The whole-hearted vocal and financial support from the local government as well as MPs of ALL political hues? Lewisham's campaign was intelligently thought out, well-run and enthusiastically supported. Its victory provides succour to NHS Trusts and services nationally, vulnerable to Government cuts because of PFI debts in unrelated organisations.
I just want to correct an error in a previous comment of mine - rushing to log the comment before going to work this morning. Lewisham Hospital is about 5 miles from Queen Elizabeth Hospital, by most direct road route. It can be over 7 miles from other areas of Lewisham, and longer by some circuitous bus routes. Kings College Hospital and St Thomas's Hospital are 3.5 miles from each other, but no-one is suggesting closing one of them because they are too close together. If Lewisham ED were to close it would leave the ED in Queen Elizabeth, Woolwich to serve the populations of Lewisham, Greenwich and Bexley which is about 750,000 people. Already the ED in Queen Elizabeth is struggling to cope because inadequate extra capacity was created when Queen Mary's Sidcup closed. So by preserving services at Lewisham the people of Greenwich and Bexley have been spared massive overload of an already stretched system - which is why the Save Lewisham Hospital Campaign has support from many people and GPs in Greenwich and Bexley.