A Royal Delivery

Lavender's blue, dilly dilly, lavender's green,

When I am king, dilly, dilly, you shall be queen.

A man drives away from a central London hospital in a black car. His wife and new-born son sit in the back. They're on their way to a new life, the first few days as a new family. Doctors, nurses, midwives, journalists and families wave them on their way. A new life! A new mother! What could be more wonderful? A precious new family delivered safely.

It is breath-taking to consider how much has changed for women in the two centuries since Queen Victoria’s perilous, chloroform-hazed delivery. 

Princess Kate had a natural hypnobirth in a dedicated hospital surrounded by a plethora of healthcare professionals. But the NHS too, provides a choice about how and where to give birth. Mothers are no longer at the mercy of our class and financial means. Hospitals provide home-from-home rooms or midwife-led birth centres alongside acute obstetric care. We have access to birth pools, stools, aromatherapy, massage, candles, soft lighting, music, properly trained midwives, nurses, obstetricians, paediatricians and neonatologists. If things go awry we have ventouse, forceps, epidural and caesarean section. 

Women can expect to hold their new born baby in their arms at home or in hospital with nothing more challenging than "what shall we call our little Prince...?" and "how does this nappy work...?" on our minds. 

It is no longer common place to die in childbirth or in the weeks after due to infection and blood loss. Thousands of us no longer perish in dirty hospitals or in fear that a doctor won't arrive in time or that the local midwife has no proper training. Our children do not have the tragic memory of a narrator in Spirit of 45, who was told after the birth of his new brother in the 30s that “your mam died but for the want of a pint of blood”.

But a new era is dawning. Across the country, maternity services are being downgraded and cut. NHS England doesn't like to admit it. Their propaganda is full of vacuous words about 'providing a safe service for women' and offering 'real choice'. But under their plans, choice and safety will be reduced, and more women will have to travel further to larger hospitals in order to give birth.

Lewisham Hospital is just one of many scheduled for downgrade by Professor Sir Bruce Keogh's trigger happy bombardment of our maternity services. This small district general hospital in South London supports over 4,500 deliveries a year. Lewisham offers a range of services to women: home birth, a prestigious birth centre and a highly successful acute obstetric labour ward. 

Should the downgrade take place, women will be 'dispersed' across several neighbouring hospitals. This will mean that thousands of women will face a travel time of over an hour in busy London traffic. Can you imagine getting a bus - sometimes two or even three - while in the throes of labour? Most residents of Lewisham don't own a car and taxis will not transport women in labour. 

St Thomas', King's and Queen Elizabeth hospitals will have to double their obstetric provision in order to meet demand. They're already running over full capacity. For women this will mean a conveyor belt care package, no continuity of care and potentially lethal transfer times in the back of ambulances.

NHS England, backed by the Secretary of State for Health, has spent an enormous amount of money to justify their claim that the priority for hospital care is 24 hour consultant cover, more centralisation and fewer hospitals. That strokes and heart-attacks can be better served by fewer, more specialist hospitals. 

But even if that is the case for those conditions, maternity isn't a disease. It isn't something that should be 'treated'. It requires a wholly different approach to other health specialities.

Private consultants like Mckinseys and Deloitte enrich themselves with their public sector work, including running sham consultations. But - as I found myself - they don't seem to find the time to actually ask women what they want or what they need. They can barely be bothered to listen to health professionals, academics or public health officials about what careful practise and research shows to be fact.

Women want and deserve to be cared for as individuals, with access to the service they personally require. Women want a named midwife. They want a safe, quiet, small environment in which to give birth. Not an over-sized, over-stretched anonymous hospital with a hive of faceless midwives and doctors.

The days in which all women could expect the same level of safety, care and choice as the richest and most celebrated women in the land will soon be over. In some parts of the country they are already long gone. 

And this is wrong. It's wrong for women, it's wrong for babies, it's wrong for public health and it will inevitably turn the clock back on the huge progress we have made over the last couple of centuries.

Lavender's green, dilly, dilly, Lavender's blue,

If you love me, dilly, dilly, I will love you.

Let the birds sing, dilly, dilly, And the lambs play;

We shall be safe, dilly, dilly, out of harm's way.

The Regime for Unsustainable Providers could be coming to a hospital near you!

I ask you, can one small district general hospital save the NHS?

The Save Lewisham Hospital campaign are hoping so and this week is going to be a crucial one for us south east Londoners. That's right folks, we've taken our fight to the High Court.

A year ago South London Healthcare Trust was put into administration by Jeremy Hunt. A Trust Special Administrator was put in post and tasked with a seemingly impossible job: sort out the ailing finances of a Trust burdened with a monstrous PFI contract.

It's a fact universally acknowledged for those in south London that SLHT has been doomed for years, there have been several unsuccessful plans to rescue it, so no one was particularly surprised when the government put it into administration. The shock came a few months later, in October, when Trust Special Administrator, Matthew Kershaw, announced that the debts of SLHT were too gigantic and complex to be solved within the bounds of the Trust alone and that he would look at neighbouring Trusts to help shoulder the burden. Suddenly the coffers of Lewisham Hospital looked quite appealing. 

Matthew Kershaw clearly thought it wasn't impossible to appropriate some of Lewisham's capital and real estate in his attempt to balance the books. Never mind that the piece of legislation he was using at the time (The Regime for Unsustainable Providers) specifically states that it cannot be used outside the Trust or for service reorganisation.

I shan't go on about the highs and lows of the campaign first to challenge the bizarre misuse of The Regime for Unsustainable Providers and then to exhort Jeremy Hunt MP to recognise the illegality of Kershaw harvesting the vital organs of Lewisham Hospital’s actute services and obstetric-led maternity care.

As you know from our previous forays into the wonderful world of publicity, we like a bit of style in Lewisham. Boris Johnson won't forget his red carpet treatment in February and I am sure I saw the curtains twitch at the Department of Health when Lewisham's Buggy Army descended en masse for a true Valentine's celebration.

So, can you blame us for attempting to make history once again?

This time we've brought in the big guns. Michael Mansfield QC and his special force of barristers from Tooks Chambers joined us for a trail-blazing run at the iniquities of this government's onslaught on the NHS. Allyson Pollock, Colin Leys and Lord Owen all spoke in defence of our precious local hospital and to paint the greater picture of the need to save the NHS from marketisation and privatisation.

Over the course of one day we heard from 25 witnesses giving evidence in a People's Commission chaired by Michael Mansfield and supported by Baroness Warnock and Blake Morrison as fellow judges. The evidence was given by doctors, nurses, patients, carers, the CEO of Lewisham Hospital and yours truly in my role as Chair of Lewisham Maternity Service Liaison Committee. In one voice we argued the case against the Trust Special Administrator and against the destruction of the NHS. It was an amazing example of People Power. I am proud to have been part of it.

Today two judicial reviews started their hearings at the High Court. By Friday we'll know the fate of our hospital.

If Lewisham Hospital is downgraded no hospital in the United Kingdom will be safe so be on your guard; watch out! The Regime for Unsustainable Providers could be coming to a hospital near you so support our campaign at the High Court before it's too late.

I'll leave you with the words of Aneurin Bevan's leaflet to launch the NHS 65 years ago

Your new National Health Service starts on the 5th July. What is it? How do you get it?
It will provide you with all medical, dental, and nursing care. Everyone – rich or poor, man, woman or child – can use it or any part of it. There are no charges, except a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in times of illness. (National Health Service Leaflet 1948)

The Blitz spirit lives on with the Save Lewisham Hospital Campaign

Don't keep Calm Get Angry and Save Lewisham Hospital

Ten little fingers born in the NHS

Ten little fingers, ten little toes,

Two little ears and one little nose
Two little eyes that shine so bright
And one little mouth to kiss mother goodnight.

Children’s nursery rhyme.

A chilly but sunny afternoon at the beginning of March. Four happy children play in a back garden, shouting and laughing. It's tea time so the children come inside for a spot of toast and cake. One little girl leans on a door frame to take off her shoes. At the same time the door is slammed shut on to the middle finger of her right hand.

She shrieks, I run, open the door and see that the top joint of my beautiful perfect five year old girl has been amputated. Before I know what I am doing I shout to my friend to get us to A&E and hold the top joint onto the finger. My little girl screams and screams, we rush into a neighbour's car and within 10 minutes we are at Lewisham Hopsital's Children’s Emergency Department.

That was three weeks ago and those 10 minutes felt like an eternity. Beatrice fainted five times in the car and I was powerless to stop the horrible pain I knew she was in. I wanted to cry and scream myself but I knew I had to be strong. The soaring relief to arrive at the hospital was immense. We were seen immediately, Beatrice was given pain relief at which point she fell into a deep sleep and I was given reassurance by the fabulous nurses and doctors. We were transferred to St. Thomas' Hospital that evening, Beatrice had surgery the next morning and we were home again within 24 hours of the terrible injury taking place. Thank you Lewisham Hospital. If you hadn't been there it would have been an hour or more before Beatrice had pain relief and the care she needed to prevent her losing her finger. Long may you stay open for business.

Toby Tall, Toby Tall,

Where are you?

Here I am, here I am,

How do you do?

Children’s nursery rhyme.

I've said it before and I'll say it again, Lewisham Hospital is a successful, solvent healthcare provider. It's the kind of hospital that David Cameron promised to champion during the election campaign when he grandly pontificated: 'The NHS is safe in my hands'.

And yet, this fantastic hospital, full of caring doctors, nurses and sensible managers is scheduled for down-grade to bail out South London Healthcare Trust in a neighbouring London borough. As wrong as it is that the people of Woolwich are being penalised for the mismanagement and bumbling decision making of politicians it really shouldn't be Lewisham Hospital's responsibility to shoulder their burden.

Jeremy Hunt and the cabal at the Department of Health tell us that their hands are tied, there's nothing they can do, they must balance the books! Don't we know there's a massive deficit? Don't we understand that the NHS is simply too expensive? All of this while they wring their hands in horror that hundreds of people died at Mid-Staffordshire NHS Foundation Trust because financial considerations were put before patient care. All of this while they promote David Nicholson who presided over Mid-Staffordshire while dead bodies were being stacked up in the morgues. And all of this while Jeremy Hunt clumsily claims to understand the clinical case for downgrading our public services. It certainly doesn't help build confidence that the Health Minister persists in clinging to the false statistic that the massive service reconfiguration in South-east London will save 100 lives. He's said it in parliament at least twice so one would assume he must be sure of his facts, especially when the entire cohort of Labour MPs from Lewisham called his assertion into question.

Even Professor Sir Bruce Keogh, NHS medical director, has tried to stop Jeremy embarrassing himself when he wrote a public letter  to distance himself from the wayward minister's gaffe. But, oh no, Jeremy bumbles on. He's even passed the misinformation to Boris Johnson, Mayor of London, who ineptly trotted it out at a People's Question Time held in the London borough of Lewisham. I wonder whether he'll listen to Jeremy again after the roasting he got from the Save Lewisham Hospital campaign?

Boris Johnson gets a taste for the outrage in Lewisham

Not only will the disastrous plans cobbled together by Trust Special Administrator Matthew Kershaw and his pals at McKinsey's and accepted by Jeremy Hunt definitely not save 100 lives, they will expose an entire borough of London to unacceptable risk. The plans fly in the face of patient care, health equality and take us back by a generation in maternity provision. I think it would be fair to say that David Cameron's pledge to keep the NHS safe is one made in pure fantasy.

One finger, one thumb
keep moving.
One finger, one thumb
keep moving.
We all stay merry and bright.

Children’s nursery rhyme.

Meanwhile Beatrice's finger continues to heal and I've been daydreaming about what I'd like to do with with my middle finger but I have to concede that this might not be the best way to negotiate with the Right Hon. Jeremy Hunt MP. Tempting though it is.

An update from Lewisham's maternity services committee

An upside to the otherwise irredeemably awful news that Jeremy Hunt, Health Secretary, has taken the axe to obstetric-led maternity services at Lewisham Hospital is that we have a really vibrant and enthusiastic committee at the moment. Five new mums have joined us and we have a record number of volunteers for our outreach programme called Walk the Patch.

This is one of the most important things we do as mums on the committee. Every month a volunteer visits the antenatal and postnatal wards to gather feedback from women who are currently using the service. This gives us a chance to understand the issues that women experience which in turn informs our agenda. It also allows us to meet and get to know the midwives so that we have a really strong working relationship at all levels in the hospital.

At our last meeting the staff from the hospital updated us on the refurbishment of the Labour ward which is taking place at the moment and is scheduled for completion by the end of May. The new Labour ward will replicate the very popular birth centre where possible so that women will be given the same attractive and high-quality environment in which to give birth. There will now be two rooms for low-risk women to use who aren't able to use the birth centre due to medical considerations that mean that they do not fit the criteria to use the midwife-led unit but are not considered too 'high-risk'. The mums of the MSLC have a date to visit the Labour ward to give advice about how to make the rooms attractive and comfortable.

This work is a commitment from the hospital to the women and families of Lewisham that the hospital is open for business as usual. The hospital has launched the Open for Business campaign to reassure the people of Lewisham that the hospital's services will continue to improve and serve maternity users and patients for the next three years and beyond.

Claire Champion, Director of Nursing, speaks about the upgrading of maternity services at Lewisham Hospital Lewisham Hospital Builds Trust

The MSLC has a diverse membership including a representative from the Lewisham refugee and migrant network. Many of the women in this group are living on roughly £30 a week to support them and their children which clearly means that some of the basics we take for granted are a serious struggle to buy. So, if you have any leftover nappies that your baby has grown out of or a cot that you don't want any more....anything at all really as long as it's in good condition and clean, please can you donate it to this marvellous centre who will pass it on to one of their families. The address is 144 Evelyn Street, Deptford, SE8 5DD. 020 8694 0323. The contact name is Margot Lawrence. If you are interested in finding out more about the group you can visit their website Lewisham Refugee and Migrant Network or you can find them on facebook.

To keep up with news and information please join Lewisham MSLC on facebook.

 If you are interested in joining the MSLC please contact Jessica Ormerod.

Who says Al Capone is dead?

Lewisham's answer to the St. Valentine's day massacre

Ander McIntyre

What better way to enjoy Valentine's Day than a spot of direct action at the Department of Health? In Lewisham we don't celebrate in secret we go out in style! 

Red heart-shaped balloons, home-made bunting to festoon the streets of Westminster, posters galore inscribed with a message from the mothers, babies, children and people of Lewisham – 'Don't rip the heart out of our hospital, Mr Hunt' and hand-delivered baby sock rosebuds for Jeremy Hunt, Secretary of State for Health, each with their own story of a baby born and saved by Lewisham Hospital. In Lewisham we don't go for subtle. We go for the jugular.

Last Thursday 14 February more than 130 babies, mums, dads, grannies and citizens of the London borough of Lewisham descended unannounced to pay a special Valentine's call on the Right Honorable Jeremy Hunt MP at his office. Sadly he did not join us to receive in person our heartfelt offerings but that didn't detract from a morning of peaceful but exuberant protest.

Our message was shouted load and proud: the fight to save Lewisham Hospital did not end with Jeremy Hunt's announcement on the 31st of January that acute services at Lewisham Hospital would be cut.

How can this small part of London have any relevance to the rest of the country and world? I hear you cry.

Ander McIntyre

The reason is this: Lewisham Hospital is a solvent and clinically well-respected healthcare provider. The fact that its fate hangs in the balance is purely financial because its vital services are being sacrificed to bail out the disastrous PFI contract that has drained to ruin neighbouring South London Healthcare Trust. So, according to Jeremy Hunt, it's now perfectly acceptable to remove obstetric-led maternity and emergency care from a population of nearly 280,000 just to balance his books. Nevermind the safety of thousands who use their hospital every day or the fact that neighbouring hospitals are full to bursting. No, the priority in healthcare these days is profitability.

The other reason is the small incidental detail that it seems the coalition government has an agenda to dismantle the welfare state. I grew up in the shadow of Thatcher so sweeping changes to benefits, education and health were a feature of my childhood and I recognise an unmandated eradication of public services when I see one.

Ander McIntyre

Lewisham Hospital is a test case for every hospital across the country. And the wholesale destruction of the NHS will have ramifications beyond our green and pleasant shores. Isn't the NHS held up as a shining light in international healthcare? If we lose healthcare that is free at the point of delivery what are we replacing it with and gone will be the days of a pioneering health model to be replicated across the globe.

Ander McIntyre

But the likes of Jeremy Hunt and the cabal in the Department of Health don't scare the residents of Lewisham. We're a plucky bunch and we're showing David Cameron what a Big Society can do when people join together and form a real community.

We're not going down without a big, public and embarrasing fight. The boys at Number 10 may think they can dismiss down-at-heel Lewisham with its massive population of refugees, asylum seekers, travellers, migrants and vulnerable families but they have underestimated the little people.

Ander McIntyre

The patronising arrogance of our well-oiled leaders will be their un-doing. We have strength and experience on our side. When many of our number have defied miliatry juntas, grown up behind the iron curtain of Communism and marched thousands of miles across deserts, steppes, plaines and the English Channel taking on a bunch of public school boys with their hands deep in McKinsey's pockets doesn't seem too much of a struggle. And, as most of us are unemployed good for nothings – in the eyes of our esteemed government – we might as well while away our days taking a stand for our hospital, our NHS and the future of Britain's Welfare State.

You can follow the campaign on facebook.

More photographs by Ander McIntyre

The campaign to save Lewisham Hospital fights on!

Dear Andy Burnham,

My name is Jessica Ormerod. I am a Lewisham resident, mother of three 
and chair of the Lewisham maternity service committee. Our committee 
represents all maternity users in the borough of Lewisham. We work with 
senior clinicians, managers and commissioners to shape maternity 
services locally.

I congratulate you on your response to Jeremy Hunt in parliament 
yesterday. I am a member of the Labour Party and as such am incredibly 
proud that all three Lewisham MPs have tirelessly campaigned to protect 
our successful and solvent hospital.

Women in Lewisham are outraged by Jeremy Hunt's decision to accept 
Matthew Kershaw's recommendations in full. The down-graded Accident and 
Emergency department is no more than a confusing and obfuscatory charade 
to blind people to the fact that level three acute services will no 
longer be available within the borough of Lewisham.

You are absolutely right that the reconfiguration planned for SLHT and 
LHT sets a dangerous and alarming precedent for the entire NHS. If a 
successful and solvent hospital such as Lewisham can be sacrificed to 
bail out a neighbouring trust no hospital in the country is safe.

Jeremy Hunt's decision to accept Matthew Kershaw's recommendations mean 
that Lewisham mothers will be denied the choice to give birth locally 
with the support of obstetricians. Women have told our committee that 
even if they are deemed fit to use the facility (and the vast majority 
of women in Lewisham will not be able to even consider giving birth in a 
midwife led unit), they would not want to run the risk of a blue-light 
transfer. Women understand that childbirth is unpredictable: when a 
doctor is required they are required quickly.

Therefore, we ask you to take this to the highest level. This coalition 
will oversee the wholesale destruction of the NHS if a serious and 
coordinated opposition is not set against their idealogical vendetta 
which has no electoral mandate.

It is a moral outrage that acute services can be removed from an entire 
London borough with a population of 250,000.

Yours sincerely,

Jessica Ormerod

The fairytale of Lewisham

Once upon a time in a land quite close to where we live now there was a hospital loved by patients, doctors and public alike. All the mummies and daddies and neighbours knew that they were safe because the hospital had all the right machines and clever doctors and nurses to look after the families of Lewisham if they got ill.

All until one day when a bumbling accountant came to town. An evil enchantment had been put on the accountant by the wicked magician Mckinsey and so the poor man could only see the world in pound notes. But children, it wasn't real money, it was the money of accountancy – a special kind of money that can disappear with a slight of hand.

The evil magician Mckinsey wanted all the hospital's money for himself and so he told the accountant to close the hospital to 'rationalise services'. All the people of Lewisham cried, 'Oh no! Don't take our lovely hospital – we love it so!'. But the naughty magician had made the accountant deaf and so he couldn't hear the people and carried on only thinking about money.

At this time, a Huntsman looked out from his tower. When he saw the people of Lewisham crying in the streets and shouting in protest he whispered to his friends, 'Who are these people? Why do they fuss? Don't they know that the evil magician McKinsey knows what's best for them? Don't they want the shiny hospital in the next kingdom we are offering them? Never mind that it's got no transport links, no matter that there will be too many people using it. People don't really need local emergency services, do they?'.

So the people of Lewisham shouted louder and refused to leave their hospital. They sent envoys to far away kingdoms to warn them that the Huntsman and the evil magician would visit them next to rationalise their services out of their hands and sell off their land to strange companies.

However, the Huntsman had forgotten that he lived in a democracy and was in danger of losing his tower. He then suddenly remembered a tale from the town he came from, where he had heard that in years gone by his hospital had also been threatened by the great dragon Austerity. He vaguely recalled that he had been one of the men who had slain the dragon and rescued the hospital.

As these memories broke through the fog of the spell cast on him by McKinsey: he was emboldened and drove the evil wizard from his tower.

Lewisham Hospital was saved and there was rejoicing across the land.

So sleep well dear children for this is only a fairy story and Level 3 acute care remains in the borough of Lewisham.

More press

To catch up with all the latest in the media go to www.savelewishamhospital.com

20,000 people march to Save Lewisham Hospital

Wow! What an afternoon that was. We're back from the march and recovering from the huge crowds with a lovely cup of tea. The kids are making an NHS boat and chanting, 'Save Lewisham Hospital, Save the NHS!'...

I've just had a look on google for publicity about the march and here are the amazing results!

The Standard's piece on the Olympic nurses

South London Press

The Daily Mail

LBC

The Guardian

The Standard...again!

Fantastic photo from the BBC

And on ITV

The Save Lewisham Hospital Campaign is hotting up

The campaign is gathering momentum by the day.

Check out these three short films from the people of Lewisham:

The Campaign's flash mob on the Department of Health

A fantastic version of Steps' Tragedy!

Check out Simone Boothe's snowy journey to Woolwich from Bellingham

Polly Toynbee BIGS UP the Lewisham Hospital March

Save Lewisham Hospital suggested letters

Some great suggestions for letters from the campaign for you to download.

Check them out here!

Write to Jeremy Hunt again!The MSLC have written a letter for you to send to Jeremy Hunt. Keep it as it is or change it as you see fit!

Jeremy Hunt

Secretary of State for Health

Department of Health

Richmond House

79 Whitehall

London SW1A 2NS

Your address

date

Dear Jeremy Hunt,

I am writing to you about the proposed closures at Lewisham Hospital of Accident and Emergency and Maternity Services.

You and David Cameron have confirmed that no closure will take place if the proposed service reorganisation does not meet the Secretary for Health's Four Tests. As I understand it Matthew Kershaw and his team's recommendations do not fulfil the requirements set out.

Despite an enormous budget that escalated dramatically, the TSA did not provide adequate resources to properly engage with Lewisham's diverse population and so you have not received a fair representation of our needs.

My family rely on the acute services provided at Lewisham Hospital. We demand that these services are kept local for the Lewisham population. The result of closure will be that people will delay going to A&E so their health will suffer because they won't receive the medical attention they require when they are most at need.

I also believe that women in Lewisham should be able to give birth in Lewisham in the safe knowledge that the delivery will be supported by the best medical attention they require.

It is unacceptable that an entire London Borough be asked to travel to Woolwich to receive emergency care. It will be very dangerous to burden the surrounding areas with the extra capacity of Lewisham patients.

I have heard much about patient choice over the last few weeks. Matthew Kershaw's recommendations reduce choice for our entire community.

I urge you to take our views into account. The recommendations do not have the support of patients, doctors, GP commissioners or the public.

Yours sincerely,

Lewisham Resident

Read Lewisham's MPs case against the TSA's recommendations

THE TRUST SPECIAL ADMINISTRATOR’S REPORT ON SOUTH LONDON HEALTHCARE NHS TRUST AND THE NHS IN SOUTH EAST LONDON
THE CASE AGAINST RECOMMENDATION 5: SERVICE RECONFIGURATION (CLOSURE OF THE A&E AND MATERNITY SERVICES AT LEWISHAM HOSPITAL)

Prepared by Heidi Alexander MP, Jim Dowd MP & Rt Hon Dame Joan Ruddock MP

Legal & Financial Case against the proposals
As the three Members of Parliament representing Lewisham constituencies, we wish to set out the reasons why we believe the Secretary of State for Health should reject proposals from the Special Administrator to the South London Healthcare Trust (SLHT) to close the A&E and maternity services at Lewisham Hospital.
We question whether the Trust Special Administrator (TSA) has the power in law to make recommendations which affect Lewisham Healthcare NHS Trust, and whether the Secretary of State, in response to these recommendations, has the power to take a decision which results in the loss of A&E and maternity services at Lewisham Hospital – a solvent, successful hospital which is not part of the Trust to which the TSA was appointed.

The TSA’s recommendation to close A&E and maternity services at Lewisham represents a significant reconfiguration of services in South East London. We note that the Government’s own guidance to TSAs states that the Unsustainable Provider’s Regime should not be used as “back-door approach to service reconfiguration” – this is exactly what is happening in South East London. It is our view that proposals relating to Lewisham Hospital such as those which have been made by the TSA are subject to the provisions of Section 244 NHS Act 2006 and relevant regulations. We do not believe that the Secretary of State has power to act on the recommendations of the TSA in so far as they relate to Lewisham Hospital. However, even if that is not the case, we do not accept that the proposals meet the Government’s Four Tests for service configuration (see below).

We understand from Lewisham Healthcare NHS Trust that they did provide an alternative approach to the TSA’s proposals. The Trust, as part of its Expression of Interest for working with Queen Elizabeth Hospital (QEH), outlined that – as an organisation with a track record of success – it should be allowed to work with GPs, patients and partners to decide what needs to be done to meet the financial challenges in the future. This approach was not pursued by the TSA.

The TSA’s report shows that significant savings can be made without closing emergency and maternity services in Lewisham. Accepting only five of the six recommendations (excluding recommendation 5 on service reconfiguration), the TSA’s figures show there will only be a financial gap of just £1.7 million from a breakeven position. The proposed new organisation would need support initially to deal with the costs of integration and improve efficiency at QEH. But as a successful organisation, Lewisham Healthcare could work to close the £1.7 million gap without resorting to the destruction of vital services.

Figure 29 of Appendix M shows that the TSA service reconfiguration proposals (as per recommendation 5) deliver only £19.5 million of savings at a cost of £195.2 million – a ten year pay-back period. In addition, Kings would receive £31.5 million in non recurrent support and £58.7 million in capital (the Princess Royal and King’s investment combined) and benefit by £7.5m annually from the re-provision of services from Lewisham.

Service Reconfiguration and why these proposals fail the Government’s Four Tests
Both the Secretary of State for Health and the Prime Minister have repeatedly stated that changes at Lewisham Hospital will not go ahead unless the four tests that Government have set for service reconfigurations have been met. We believe that TSA’s proposals fail each of these tests. We list the reasons below:
1. Support from GP Commissioners
(i) The proposal to close the A&E and maternity services (with the consequent sale of over half of the Lewisham Hospital site) is not supported by Lewisham’s Clinical Commissioning Group (CCG).
(ii) Two thirds of Lewisham GPs have signed a letter to the Prime Minister setting out their opposition to the plans.
(iii) The Lewisham CCG and local GPs do not accept a clinical case has been made for these proposals and do not believe that the proposed Urgent Care Centre model will work. They state that local GPs will be inclined to refer patients to hospitals with emergency departments for specialist opinion, with a consequential impact on the number of patients who present at a Lewisham UCC.
(iv) Lewisham CCG and local GPs are also sceptical of the assertion that acute admissions can be reduced by 30% over 5 years – resulting in a situation where acute capacity will still be required but will not exist. There is no evidence to back up the assertion, upon which these proposals are predicated, that acute admissions can be reduced by 30% through the implementation of a community based care strategy.
(v) The TSA uses quotes from other SE London CCGs as evidence of GP Commissioner support, yet no change is proposed to the provision of emergency and maternity services in the areas which these CCGs directly cover.
2. Strengthened Public and Patient Involvement
(i) The public and patient involvement has been flawed. The 30 day public consultation on the TSA’s draft recommendation, whilst required by statute, is not consistent with Cabinet Office Guidelines nor does it meet the requirements of Section 242 of the National Health Service Act 2006, as would be required by a major reconfiguration.
(ii) The consultation was woefully inadequate. The consultation questions were opaque and confusing. There was no clear question about Lewisham A&E and no question at all about the sale of over 50% of land and buildings at Lewisham. Numerous people who attempted to reply to the consultation online have told us that they simply gave up.
(iii) Final recommendations in the report to the Secretary of State about services at Lewisham were not even included in the public consultation on the draft proposals (for example the midwifery-led birthing unit and the paediatric ambulatory service).
(iv) Important assumptions contained in the draft report, such as the percentage of patients who would continue to be treated at an Urgent Care Centre at Lewisham, have been proven to be erroneous.
The final report of the TSA suggests 50% of Lewisham A&E patients would still be treated at the UCC. The draft report suggested it would be 77%. Hospital doctors from Lewisham, based on an analysis of their caseload, suggest this figure is closer to 30%. This has an obvious impact on the additional capacity required at neighbouring hospitals to cope with displaced work from Lewisham, and means that the consultation proceeded on an incorrect and flawed basis.
3. Clarity on the Clinical Evidence Base
(i) The report assumes that the better health outcomes associated with the centralisation of major trauma, stroke and complex vascular conditions will be replicated with respect to other medical emergencies (for example pneumonia, meningitis, sickle-cell crises), yet there is no clinical evidence to support this.
(ii) The standards of care delivered at Lewisham’s A&E are high and have consistently outperformed other local emergency departments. For example, in 2010/11 and 2011/12 the emergency departments within SLHT failed to achieve the 4 hour standard, yet Lewisham consistently exceeded it. The quality of care given to newborn infants and children in Lewisham is also high and it has been the only London District General Trust to gain an “excellent” rating from the Health Care Commission in recent years.
(iii) Consultant involvement in both pre-operative decision-making and surgical supervision, noted as a key component of good emergency care by the TSA in paragraph 49 of Appendix K has been recognised by London Health Programmes in their 2012 survey as being present at Lewisham, but not at other hospitals (excluding Kings) (p. 71 of final report).
(iv) The proposals will lead to larger maternity units on fewer sites in South East London when there is no evidence that “bigger is better” in respect of maternity care. The Borough of Lewisham’s population is forecast to grow by 49,000 in the next 20 years, much of this driven by an increased birth rate (a 4% year on year increase is predicted). Lewisham has a high rate of teenage pregnancies and the percentage of older mothers is also above the national average. Continuity of care, with women having ante-natal care provided in Lewisham but having to go to another hospital to give birth will be seriously compromised as a result of these proposals and would require additional staff added to the consultant obstetric rota at King’s and then QEH as births on each of those sites exceed 8,000.
(v) During the TSA process, the output of the clinical panels has been used as a proxy for clinical evidence. However clinicians in Lewisham have told us that no dissent was allowed in panel meetings, no votes were taken and that the output of these panels should not be relied upon as clinical evidence.
4. Consistency with current and prospective patient choice
(i) Closing the A&E and maternity services at Lewisham and replacing them with a UCC and a midwifery-led birthing unit significantly reduces choice for the residents of Lewisham. Figures 40, 41 and 42 in the TSA’s final report show that the number of A&Es that will be within 30 minutes of people in South East London, travelling by either ambulance or using other modes of transport, falls. Journey times for people in Lewisham to A&Es will increase.
(ii) Whilst the proposed UCC at Lewisham will be an option for patients with minor injuries, it will not be a meaningful choice for a patient with an undiagnosed complaint needing specialist assessment or possible admission.
(iii) The proposed midwifery-led birthing unit at Lewisham will not be a choice for any woman who wishes to give birth safe in the knowledge that obstetricians would be available as a back-up. It may lead to more home deliveries and the hard to reach population will find it harder than ever to get access to timely care.
(iv) Closing Lewisham’s A&E and maternity services will have a disproportionate negative effect on socially and economically deprived groups, which make up a significant proportion of Lewisham’s population. The Health and Equality Impact Assessment in the final report, which purports to consider this point, was not included in the consultation. It cannot therefore properly have helped form the recommendations, but instead appears simply as a post-rationalised justification for them. This is a further example of the flawed nature of the consultation process.
Conclusion
The proposals to close A&E and maternity services are dangerous and ill-conceived. Destroying a successful hospital by closing vital services is not in the best interests of the people of Lewisham, nor is it financially necessary. It would only make a saving of £12.2M (the approximate cost of Lewisham’s recently refurbished emergency department). Figure 47 of the final report details the saving for each of the TSA’s 6 main recommendations. If nothing is done, there will be a financial gap of £75.6M by 2015/16. However, if five of the six Recommendations are accepted (excluding recommendation 5 on Service Reconfiguration), the TSA’s figures show there will be a financial gap of just £1.7M from a break-even position. Additionally, the TSA service reconfiguration proposals (as per recommendation 5) deliver only £19.5 million of savings at a cost of £195.2 million – a ten year pay-back period. An alternative to solve this gap has been proposed.
We urge the Secretary of State to reject Recommendation 5 and to retain a full admitting A&E and full maternity service at Lewisham Hospital.
For more information:
Heidi Alexander MP (Lewisham East) – 020 7219 7099 – heidi.alexander.mp@parliament.uk
Jim Dowd MP (Lewisham West and Penge) – 020 7219 4617 – dowdj@parliament.uk
Joan Ruddock (Lewisham Deptford) – 020 7219 4513 – joan.ruddock.mp@parliament.uk

ITV London News cover the cuts 14th Jan 2013

Lewisham mums and pensioners talk to the press about why the proposed cuts to our hospital are so dangerous.

Check out the story here The ITV News Story

The second letter to Jeremy Hunt

Dear Jeremy Hunt,

Last week in parliament you told Andy Burnham and the House that you would not close Lewisham Hospital's A&E department or the full acute maternity service if the TSA's recommendations do not fulfil the Secretary of State for Health's Four Tests.

We are writing to point out that Matthew Kershaw and his team have totally failed to meet the criteria set.

First, there must be clarity about the clinical evidence base underpinning the proposals.

Lewisham's Obstetricians and Gynaecologists have publicly stated that they will not support a stand-alone birth centre. The women of Lewisham put their faith in the expertise of these senior clinicians. We do not believe that a stand-alone centre is safe.

Many women in Lewisham will be considered as too high risk to use the facility and that due to the unpredictability of childbirth the few women who can use it will often require transfer. This will be dangerous in view of the travel time required to reach the proposed acute service at Queen Elizabeth in Woolwich.

The recommendations put much emphasis on the need for all hospitals to provide 24-hour consultant cover. There is evidence that this is not required for safety of patients. If you take this argument out of the recommendation, then the need for a huge maternity hub can no longer be defended.

Second, they must have the support of the GP commissioners involved.

GPs have unanimously and publicly told the Trust Special Administrator and Department of Health that they are against the proposals. As users, we put our faith in our GP commissioners who are experts in the field. Since they categorically do NOT support the proposals, the recommendations have absolutely no credibility

Third, they must genuinely promote choice for their patients.

The recommendations will reduce choice for maternity users.

We believe that the option of home birth will no longer exist, as women will not want to use a service that is not backed-up by a local acute service.

Women in the community have stated that they will not use a stand-alone facility due to the high risk of not having an acute service on site. It will become a very expensive facility for very few women.

A large percentage of Lewisham maternity users will be forced to use Woolwich as they will be considered too high risk to use a stand alone birth centre. Already a high proportion of the population are transferred to hospitals such as St Thomas' and Kings, and this proportion will only increase, since the criteria for using the birth centre on the same site as the level 3 service is already very limited. A large portion of the population will therefore have no access at all to a local maternity experience.

It is known within the medical profession and within the community that continuity of care suffers with an increase in the number of 'hand overs' between professionals. All Lewisham residents will suffer as they will receive antenatal care in the community, care in labour by another set of midwives and then yet another change with postnatal care, which will take place both in the hospital and within the community. This will be made even more complicated by many women choosing to use other hospital trusts for the actual birth.

There are serious safe-guarding and child protection implications involved with such hugely complicated care packages.

Fourth, the process must have genuinely engaged the public, patients and local authorities

We insist that you acknowledge the fact that there has neither been enough time nor resources allocated to have genuinely engaged with the public, patients or local authorities.

We have already outlined in detail the many instances in which there has not been a proper consultation. Please refer to our letter dated 10th January 2013.

We contacted Matthew Kershaw during the consultation period to share our concerns that the women we represent had not been properly consulted. We were offered a one-to-one meeting with a member of the TSA team at 8pm on the night before the deadline for public responses to the consultation. No-one can claim that this was a serious attempt to garner women's views.

The service-users of Lewisham's Maternity Service Liaison Committee demand that Matthew Kershaw's absurd and dangerous recommendations should be consigned to the rubbish bin where they belong.

Yours sincerely,

Jessica Ormerod

Service-user Chair Lewisham MSLC

Lewisham in the press

Momentum is building: the proposed closure is getting a lot of press.

Here are some of the articles:

The Guardian

The Mail on Sunday

The Standard

The Standard again

And The Standard again!

And catch up on the debate between Jeremy Hunt, Heidi Alexander and Joan Ruddock onThey Work for You.

The Lewisham MSLC are proud to present our Annual Report 2012. Read all about our achievements over the last year.

Lewisham MSLC Annual Report 2012

If you are interested in joining the MSLC or have any suggestions for areas you would like us to focus on then get in touch with us on our facebook page Lewisham MSLC or you can email jessica@ormews.com.

The MSLC write to Jeremy Hunt

Dear Jeremy Hunt,

I am writing to you as the Lay Chair of the Lewisham Maternity Service Liaison Committee (MSLC) regarding the inappropriate use of the Regime for Unsustainable NHS Providers to reconfigure health services in South East London.

I am very concerned about the Regime’s apparent intention to harvest the vital services from Lewisham Hospital in order to save the ailing Queen Elizabeth Hospital. We believe that this is an at best dubious and quite possibly actually unlawful use of the legislation, and we would like to take this opportunity to inform you that should this case come to Judicial Review, we shall support the rejection of the recommendations.

Before you make your decision, please focus on these three critical areas:

1. The Regime for Unsustainable NHS Providers is being wrongfully employed
It is clear from the Statutory Guidance for Trust Special Administrators appointed to NHS Trusts (DoH, 2012) that the reconfiguration of services outlined in Matthew Kershaw's Draft Report falls outside the remit of the Regime. This is explicitly stated on page 6: 'The regime does not provide a back-door reconfiguration of services'.
Moreover, it is claimed that:

19. The Regime is intended to protect patients and staff from failing services, ensuring good local services for all patients.

It is unjustifiable that in order to save Queen Elizabeth Hospital, Lewisham residents' access to high-quality, safe and effective services should be removed.

I refer to p. 7: PRINCIPLE 1 - Patient interests must always come first. The most important consideration is the continued provision of high-quality, safe and effective services so that patients have the necessary access to the services that they rely on.

The Regime has not been 'credible' or 'workable' (p. 7 Principle 5). Despite the fact that the TSA held public meetings, there was no attempt to give sufficient resources to adequately consult service users – particularly the large quota of seldom-heard groups resident in Lewisham. This is despite the essential principle in the Statutory Guidance 'that patient interest should come first'.

Women who attended the two hastily organised focus groups reported that the organisers overtly suggested that Lewisham medical staff were against the proposals because they wanted to save their jobs. This is an example of the clear determination of the TSA to shut down open discussion and does nothing to encourage confidence that the Regime is either open or independent.
The experience I had when attending a meeting convened by the TSA team and Mckinseys, which claimed to be a 'workshop' with senior clinicians, commissioners, midwives and managers across South East London Service Providers, was breathtakingly patronising and dismissive.

'The Trust Special Administrator is required to undertake an equality impact assessment, observing equality legislation and principles, and demonstrating that due regard has been paid to the equality duty of the Equality Act 2010. The equality assessment should apply to both patients and staff. It is recommended that the assessment is undertaken early on in the Regime to allow the Trust Special Administrator to identify, for example, groups with protected characteristics that may be affected and which the Trust Special Administrator’s draft report can take into account'. (p.13). However, the assessment managed by Deloittes will not be published until the Final Recommendation has been submitted. It thus cannot be used to influence his decision and therefore he won't have complied with the statutory regulation.


2. The Secretary of State's four tests will not be met
It is stated that,
'local reconfiguration plans must demonstrate support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice. These tests were set out in the revised Operating Framework for 2010-11. For example, it is important that there is strong clinical evidence that the recommendations will deliver safe and effective care.

Lewisham Healthcare Trust, amongst others, has responded to the TSA that there will be a seriously negative impact on the delivery of safe and effective care on the residents of Lewisham. There is clear evidence that women and infants will be put at serious risk should Lewisham Hospital lose its acute services.

It is also a fact that clinicians, commissioners, managers, midwives and service users were not given the opportunity to contribute substantively to the models used by the TSA in his draft report. The overwhelming majority do not support the recommendation.

It is indisputable that The Secretary of State's four tests have not been met.

3. Maternity Matters has been completely disregarded.

Maternity Matters requires that all women should have, ‘choice of place of birth. Depending on their circumstances, women and their partners will be able to choose between three different options. These are:
• a home birth
• birth in a local facility, including a hospital, under the care of a midwife
• birth in a hospital supported by a local maternity care team including midwives,
anaesthetists and consultant obstetricians. For some women this will be the
safest option.' (Maternity Matters, 2007, p.5)
I refer to the words 'local facility'. A local facility is not one that requires a woman to travel a minimum of 40 minutes in labour in order to give birth. It is very likely that home birth will disappear as a viable option and it is also evident from consulting with women that they will not use a midwife-led birth centre that is not supported by an acute service on site.
It is therefore plain that the recommendation will not be compliant with Maternity Matters.


In the TSA's haste to conjure a cost-cutting exercise in bureaucracy to camouflage a failing Trust, the rights of women in Lewisham to a local and coherent maternity experience has been totally overlooked.

Yours sincerely,


Jessica Ormerod
Service-user Chair Lewisham Maternity Service Liaison Committee


More about MSLCs: In Lewisham we have an active MSLC. The committee is a multi-disciplinary forum bringing together different professions involved in maternity care and a diverse range of user representatives in order to ensure that maternity services commissioners and maternity care provider units take account of the views of women and families using the service. It is in this capacity that the service user members draw your attention to the depth of our concern for the welfare of the women and infants we represent.