Friday, January 17, 2014

Queens and King George Hospitals
- The A&E Question

Report by our Health Correspondent, Barry Fleetwood

The absolute refusal of ministers and the Trust to even reconsider the closure of King George A&E is simply a disenfranchisement of the voters of BHR Trust hinterland - not only these three boroughs but also abutting boroughs; we have an arc from Epping through to Grays that may use Queens which makes close to a million people being served by Queens.

We do not yet know how big the reconfiguration at Queens will be, but it will certainly not be enough, and the irony is that as the population of this part of London explodes, and the existing population ages, it is likely that by 2020 (with perfect sight) the Trust will almost certainly have to open another A&E because Queens will be in exactly the same position as it is now, trying to push a gallon into a pint pot.

We have another problem. The Barts Trust which runs Whipps Cross, has 4 A&E Units in East London. It is not rocket science to work out that it will not be able to finance 4 units for much longer, and although nothing is public, it is likely that at least one A&E will have to go. Whipps Cross is the oldest and furthest out, work it out for yourself.

Let us examine the Reconfiguration. Most of this is now public domain for King George, which will go from a modern Acute General District Hospital to the largest Polyclinic in the world with no A&E - not what it was built for. The Trust has laid out what bits of the hospital will be used for what purpose, and said “Those parts not used we will find uses for” - which we all know is Trustspeak for selling off as much as possible.

Although the Trust does (will?) not publish the A&E split between KG and Queens, from the little information that is available it would appear that KG is close to the 95% 4 hour waiting time target, whilst last week Queens "officially" had an average of 84.1% but it is probably nearer 76-79%. Nor will the Trust publish the patient split between KG and Queens - the only figures we have are from a very obscure document “Quality Account” 2012-13. These figures are a year old (and have probably increased).

Let's examine these figures. 200 patients per day at King George works out to 73,000 per year, but they saw 100,476 in 2012/13. And the combined figure for both units is 248,000 per year compared with the 199,000 figure quoted in the list of largest A&Es at the top of this post. Let's hope the finance dept. dealing with the PFI repayments is a little more robust with its numbers ...

Although the KG reconfiguration has been published, absolutely nothing has been published for Queens. These questions remain unanswered
  • The current alleged capacity of Queens is 90,000 p.a. At 350-400 per day it is already 50-60% over subscribed. No capacity has been promulgated for the Reconfiguration.
  • The cost of the Reconfiguration appears to be unknown to both the Public and the Trust itself. This financial year the Trust will have a deficit of between £27 -£33 million, to add to the already existing £100M + deficit - just how does the Trust propose financing the Reconfiguration?
  • Ministers, Trust Executives and CCG executives have all used the phrase “KG A&E will not be closed until it is Clinically safe to do so". The Minister has refused to name the criteria to be used. The Havering MP Andrew Rosindell has ignored a request to ask the minister to name the criteria and quantitative figures to measure “Clinically Safe”.  No-one seems to know what this phrase means, unless one believes in clairvoyancy. 
Now let us examine how big the reconfigured A&E needs to be. Currently we have between 130,000 and 146,000 for Queens and between 70,000 and 100,000 for KG making a total of between 200,000 and 246,000 for a combined single unit with a current capacity of 90,000.

The Trust believes (we have not seen the supporting evidence) that 30% of KG A&E patients will transfer to Queens A&E when KG is closed. This assumes that patients know the difference between an A&E and a walk in centre and are clinically competent to judge which one to use. We suspect that the figure is more likely to be 80-90%. So even at the minimum we have 151,000 to 176,000 patients to cope with. In addition the NHS recognises that for a new A&E there is a 15-20% increase over and above the normal number of patients for the first 6 months.

None of this appears to take any account of the predicted increase in population even though the Trust is legally bound to publish a 5/10/20 year plan and forecast for new A&E facilities.

We already know that very large A&Es perform significantly worse than the smaller ones, and Queens is starting from an already dangerously low point in performance. The people of the three boroughs expect and deserve something better than this. The original consultation stated that the reconfiguration would deliver a much safer, better performing and more efficient A&E. If, as seems likely, that Unit will have to deal with nearly a quarter of million patients a year can we really expect that to materialise?

And we have not even considered the huge number of Consultants, middle range and junior doctors that will be needed, along with nurses and support staff, at a time when the Trust is unable to fill its current vacant positions. We have yet to see the alleged 30+ doctors from India actually in place and remain in place once here.

The last question is under the PFI agreement does Sodexo have to be used to do the actual physical reorganisation of the hospital, no doubt at a hugely inflated price, or can such a major set of building works be done by an outside contractor?.

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