Save Lewisham Hospital Campaign – guidance on responding to the Trust Special Administrator’s proposals.

The Trust Special Administrator (TSA) is consulting on his proposals to close most of Lewisham Hospital’s services. The consultation document is very long, is based on faulty assumptions and seems designed to give the answers he wants. I have been a GP in Lewisham for 20 years. This is my advice on how to respond if you want to preserve Lewisham Hospital services. I refer to excellent open letters from the hospital’s doctors, published on our website: www.savelewishamhospital.com.

Question 13 on the plans for delivering urgent and medical care in south east London.

I advise you to answer “strongly oppose” to Question 13 as this is the proposal to close Lewisham A+E

The TSA proposes closing Lewisham A+E and replacing it with an urgent care centre run by GPs and nurses. The TSA says people in Lewisham won’t notice much difference because already 77% of A+E attendees don’t need to be seen by an A+E doctor. This is completely wrong. The A+E doctors’ letter on our website (www.savelewishamhospital.com) explains why. In fact about 70% of people who attend Lewisham A+E will still need to attend A+E and will have to go further afield if Lewisham A+E closes. The TSA also underestimates the number of seriously ill people who attend Lewisham A+E. There are no credible plans to increase capacity in hospitals like Queen Elizabeth or Kings to deal with this huge increase in demand from Lewisham patients. Already overstretched A+Es there could be swamped, with people having to wait much longer to be seen. QEH is sometimes too full to take emergencies and people are often diverted to Darenth Valley or further. Delays could mean some seriously ill people could suffer longer or die before they get attention. This is a risk that is not mentioned in the TSA draft report. The TSA implies that emergency medical and surgical services in Lewisham are unsafe. This is not true. All hospitals will have to implement plans to increase senior doctor cover – it is not a justification for closing services.

Most people in Lewisham don’t know how to get to QEH. It is poorly served by public transport. Travel times in the TSA report are inaccurate. He says it would only take another 13 minutes for Lewisham residents to get to QEH by public transport compared with getting to Lewisham Hospital. Visiting relatives in hospital will also be more difficult and expensive. In practice many patients will go to Kings or St Thomas’s A+E – which will undermine the TSA’s financial plans which depend on Lewisham patients using QEH A+E.

Some vital issues not covered in the TSA report are the fate of children’s and mental health services and medical and nursing training.

A+E is the “front door” of a hospital through which patients are admitted to the medical and surgical wards and intensive care services. All these wards and services will be closed if we lose our A+E. A+E closure signals the death of a hospital as other service closures follow and eventually the whole site becomes unviable and gets sold off. The TSA has earmarked 60% of Lewisham site for sale. Once it’s gone we can never get it back.

Question 15 on maternity services

I advise you to answer “I do not support either of these options” to this. Both options are unacceptable:

One option is to lose our maternity unit – with 4000 births a year this is just not feasible. Neighbouring hospitals do not have capacity and will be swamped. Pregnant women will suffer a decline in standards of care, access and choice. The other option is a “stand alone” obstetric led unit with no urgent medical, surgical or intensive care back up when things go wrong. For example there won’t be 24 hour access to blood transfusion services for women in labour. Several confidential enquiries into maternal deaths have highlighted the risks associated with not having on site transfusion services for an obstetric unit. Please see the letter expressing the unanimous opinion of all the obstetricians in Lewisham Hospital that this unit will be unsafe. This letter is on our website www.savelewishamhospital.com.

Question 11 on community based care strategy

I advise answer “strongly oppose” or “no views either way” to this.

A major part of the TSA proposals depends on the idea that increasing GP and community based care will reduce hospital admissions. Although it sounds like a good idea in theory, in fact there is absolutely no evidence to support it – which is why they use words like “aspiration” and “vision” a lot when they talk about it. As a GP I’ve been hearing this for 20 years. It’s always used to justify hospital closures but the necessary investment in community care never materialises. We should not reduce hospital services until we have invested sufficiently in community care and shown it really does reduce need for hospital care –something that could take many years to reach fruition.

Question 17 on planned care

I suggest you answer “strongly oppose” to this

The idea is to spend £55 million on the new Riverside building to turn it into a centre to provide surgical “production line” services that all hospitals in south east London can use for non-complex surgery. The letter on our website from the anaesthetists at Lewisham Hospital explains why this is unfeasible. It assumes other hospitals will pay Lewisham to use their surgical facilities. There is no obligation on them to do so and it is difficult to see why they would as they have their own theatres. It’s likely this will be used by private health companies to treat low risk private patients.

Questions 1 – 7 on services in Greenwich, Bexley and Bromley

I will be ticking “strongly disagree” to these questions as they are based on the same faulty assumptions as the rest of the TSA report. The so called “efficiencies” are about sacking hundreds of doctors and nurses. Considering the increased demand from patients in Lewisham being diverted to Greenwich, as well as rising populations, there will be a need to retain or expand our health care staff and capacity.

Dr Louise Irvine, Lewisham GP and chair of Save Lewisham Hospital campaign