13 thoughts on “‘Special Administrator’ speak”

1. Margo Sheridan says:

   “A few patients will be affected by the downgrading of Lewisham A&E” = 25,550 patients per year will be affected by the downgrading of Lewisham A&E.
   This estimate is based on the following paragraph on pages 67-8 of the Draft Report:
   “It is estimated that around 77% of the patients that currently attend University Hospital Lewisham for emergency or urgent care would be able to continue receiving their treatment from the urgent care centre. This means that around 70 people per day, who would currently attend University Hospital Lewisham, will be taken to a different location by London Ambulance Service, self-select to attend elsewhere or will be treated, stabilised and then transferred.”
   Do the math,Matthew!

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   • androo235 says:

     I want to support this campaign to oppose the “closure” (though,of course, some other sites will see “openings” and “expansions”) but find it too hysterical. It has been known for years that inner-London has over, or at least an inefficient, provision of hospital services and past attempts to reorganise and rationalise them have met with this sort of opposition. In the good times I suppose it wasn’t worth the effort, especially for a Labour government, of facing the opposition down and pushing through change but now it’s different.

     I agree with much of the above, for example, why can’t some of the pfi debt be re-negotiated (which leads into other arguments about the merits of pfi itself and wider argument about society and our monetary, economic and tax system, for me, see postivemoney.org and landvaluetax.org) but, well, staying on this narrow issue, let’s take the points in the comment above.

     So, about 25,000 people a year will have a different experience to that they may have now. Meanwhile 85,000 people will have roughly the same, or perhaps even a better experience. Of the 25,000 having a different experience, some will be taken to one of the four full A&E’s by ambulance, some will self-select to go to one of the four full service A&E’s, others WILL BE TREATED AT LEWISHAM, and then after stabilisation will be transferred elsewhere.

     This is a bit like American politics and gun law. Any changes proposed to the NHS, our system of healthcare delivery, are opposed on principle. Change, whatever it is, is attacked as being motivated by a desire to “privatise” or seek “profit” no matter what its merits and whether either of those things are actually involved. In this atmosphere the only time that change can happen is during times of stress, such as now, like US gun law, and at these times everyone’s motives become mixed.

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2. Sally Watson says:

   The statistic quoted by the TSA that Lewisham Hospital will make a £3m loss and therefore be “financially unviable” by 2015 is wholly incorrect. This is because the TSA has used a particular definition of “financial viability” which is based on the financial performance of the top performing hospital in London, The Royal Free (incidentally, Lewisham Hospital is the fifth best performing hospital at the moment, very close to numbers 2-4). As The Royal Free makes a 1% net surplus on its annual turnover, Lewisham is expected by the TSA to do the same- he calls this the “golden benchmark”. Lewisham Hospital is forecast to make a £600,000 loss on a turnover of £24m in 2015 (an extremely small loss when compared with other NHS hospitals) instead of the required 1% surplus on that turnover ie. £2.4m.
   Because of this , Lewisham is regarded as being “financially unviable” by 2015 because of the gap between the projected £600,000 loss in 2015 and the required 1% surplus of £2.4m- add those figures together and that is how the TSA has arrived at the so-called “loss” of £3m. It is referred to as the “gap to surplus”. The projected loss in 2015 must also be fairly provisional given than the new commissioning regime has not yet become operative.

   Several points:-

   1. What is the incentive for a hospital to be well run and to make a surplus if by contagion it is required to bail out non-performing hospitals? On this basis The Royal Free had better watch out as it might be required to bail out Kent hospitals!;
   2. Since when has it been a requirement that not-for-profit organisations such as NHS Trusts make a surplus as opposed to breaking even by ploughing its surpluses back into the provision of services? On that basis they might as well make a loss and be bailed out by other NHS Trusts as any surpluses may be swept into a Government pot;
   3. There is no problem in trying to reconfigure services to make them better if that is the starting point and prime motivation for the exercise rather than the rescue of a bankrupt organisation.

   Finally, there are some extremely opaque figures as to the estimated length of time it will take a a blue light ambulance to get to Woolwich A&E as opposed to Lewisham. The question should be asked: if someone is knocked down outside Lewisham bus station in Loampit Vale at 6.30pm on a dark winter’s night, what is the exact route an ambulance would take to get to Woolwich A&E, bearing in mind that it will have to get to the other side of the A2 during rush hour?

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   • androo235 says:

     But my understanding is that “trauma” services will still be available at Lewisham so someone hurt in a car accident in Loampit Vale will still go to Lewisham. Is this wrong?

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     • androo235 says:

       Oh, just to be clear, all your points about the finances themselves and the mixed motivations to be in surplus etc are excellent. Although, to be mischievous,this could be an argument for hospital services to be delivered by private concerns who would have no such mixed motivations and so make the game theory calculus of running at least some aspects of the NHS a little simpler.

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6. Jeffrey Smith says:

   Clearly Mr Kershaw should look up the definition of ‘dissembler’!

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7. Sally Watson says:

   One other important point- the population of the borough of Lewisham is almost 30% higher than the figure of 250,000 used by TSA in his report. According to the March 2011 census , the results of which are on the Mayor of London’s website, Lewisham had a population of 275,000. As the census was almost 2 years ago now and also showed that the population of Lewisham has grown on average by 2,500 additional people each year since 2001, the current population is most likely to be around 280,000.

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   • androo235 says:

     Even at 280,000 that’s still only 10% or so and nothing like 30%. I assume you meant almost 30,000 (persons) higher – which, given your reckoning is about right. That’s still significant but it’s not 30%.

     Also, earlier, I think you referred to Lewisham NHS’ annual revenue as £24m I think you meant £240m. In this case your point that a £600k loss is small beer at about 0.25% of their budget is well made. Such a small overspend is easily managed away locally and quietly. Moreover, it is merely a forecast and forecast budgets this far away from the event still have something of the quality of wish lists about them. So you’re right, for Kershaw to use this to somehow indicate that Lewisham NHS is itself in nascent financial trouble is misleading, although useful for him I guess.

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     • admin says:

       Thanks very much for your points about the figurees – I ll pass these on
       Admin

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8. paper heavier says:

   With thanks from Forkill 😉

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