Thursday, 10 January 2013

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:
  1. 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.

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