A meeting dominated by the A&E closure decision
When the SaTH Board met on Thursday 25th October, they were joined by around 40 campaigners, strongly opposed to the overnight closure of the A&E at Princess Royal Hospital.
The SaTH pretence on Thursday was that no decision had been taken on overnight A&E closure. Really? One brief exchange gave the game away:
One Board member said, “What happens when it closes?”.
“IF“, barked the Chair.
“Yes, what happens IF it closes”, said the Board member.
Despite the games playing, the Board was on the back foot for much of the meeting. Sharp challenges from campaigners forced them to tear up the planned agenda. The Chair started off by announcing that public questions on A&E closure would be taken at the end of the meeting – many hours away. There were shouts of “shameful”, and he was told he was treating the public with contempt.
He eventually backed down. The meeting was dominated by a public session on A&E closure that ran for about an hour. And these were not deferential ‘public questions’. These were sharp, well-informed – and angry – challenges to plans that put lives at risk.
Again and again, Board members looked anxious. They simply had no convincing answers. Yes, they still intend to push this massive attack through. But they were on the defensive, again and again and again.
They conspicuously failed to give a coherent account of what their plans are. Last month, they were very clear that the decision was for pushing ahead with overnight closure of the A&E at Princess Royal. This month – reflecting the massive anger from local people – there were repeated assurances that “This is not our preferred option”, “We do not want to do this”, “We are doing everything we can to avoid this” and so on. And yet they’ve already set a date of 5th December for closure!
They were challenged hard by a Defend Our NHS supporter on their incompetence or reluctance when it comes to recruitment. We know from a well-substantiated BBC report that SaTH was sent a letter by Health Education England inviting them to apply for further doctors. They forgot to reply! Last week, SaTH told the BBC this was an “administrative error”. But at the Board meeting, Chief Executive Simon Wright dismissed this as “a piece of mischief”. They could do better at sorting out their story.
On recruitment, again. The Chief Executive of the Royal Wolverhampton NHS Trust – likely to have SaTH’s spare patients dumped on them – has criticised SaTH’s failure to recruit. He says SaTH refused to participate in a ‘Clinical Fellows’ programme that has delivered 140 doctors for Wolverhampton – and saved them a whopping £2.7 million that would otherwise have been spent on locums. SaTH could have been a part of this. SaTH chose not to be. In response to a sharp challenge, Medical Director Edwin Borman said “We were unable to take it forward” but could not explain why. No need to worry, though. Edwin says any criticisms are “mischief making”. Disagree with SaTH bosses? You’re just being mischievous!
Workforce Director Victoria Maher was sharply criticised by David Sandbach, former Chief Executive of PRH, on the bog-standard package they’re offering to ‘attract’ new doctors. She assured him that they discuss accommodation one on one with overseas doctors applying for work. It’s just that they haven’t got around to updating their recruitment material to let anyone – overseas or UK doctors – know that there is help available with accommodation. They might get around to putting it on the website next week, apparently.
A campaign supporter wanted to know the cost of increased ambulance provision, and who was going to pay. WMAS has estimated an extra £1.7 million (although they don’t currently have the vehicles or crews to do the work). Simon Wright assured her that the CCGs would pick up the tab – and another campaigner pointed out to him that Shropshire CCG says they’re not paying a penny. Let’s hope they get that one sorted out.
And most importantly, the risks to patient safety remain overwhelming. A Defend Our NHS supporter raised one key example in the meeting. Last month’s Board paper commented on the risk of separating Head and Neck services (at PRH) from A&E (to be only at Shrewsbury overnight). The risk is that ‘critically ill patients with compromised airways will not have access to relevant specialist care’. The mitigating action last month is ‘Patients will be conveyed to neighbouring Trusts via Paramedic emergency ambulance’. Critically ill and can’t breathe? That’s a bit of a problem, surely?
They were challenged on this: told that children would be particularly affected and asked why the risk had vanished from the updated risk register. They acknowledged they currently have no solutions. Medical Director Edwin Borman said, “This is an area we need to explain”. He was reminded (twice) that we were talking about critically ill patients with compromised airways, potentially at imminent risk of death. The discussion was closed down by the Chair, who said we had to respect that the Medical Director has this under control.
The consensus amongst campaigners at the meeting is that these people have not got their act together. They can’t decide if people are queuing up to work at SaTH or if recruitment is close to impossible – and claimed both in the space of an hour. They can’t explain why keeping the A&E open with increased locum cover is more dangerous than ferrying patients around the West Midlands, in non-existent ambulances, to hospitals that don’t have the capacity to treat them. They have no answers at all to the massive risks that this cack-handed plan will create.
It’s not just time to keep up the pressure. We need to increase it.
A victory on blood tests
There’s maybe a limit to how many battles SaTH can take on at once. Six months ago, SaTH closed the phlebotomy clinic – the blood test clinic – in Shrewsbury town centre. This was used by around 300 patients a week, many of them frail elderly people. A few months on, SaTH surveyed users – and brought a paper to the Board that ignored the results, and that showed no attempt to find out if this amounted to discrimination on the grounds of disability or age. The recommendation to the Board was to endorse closure. A local GP attended this part of the meeting and told them just how harmful the closure had been.
In a U-turn, several Board members – including the Chief Executive – accepted that they’d got it wrong. The paper was withdrawn, and they will supposedly come back with new proposals. They certainly need to, and Defend Our NHS supporters will be taking this fight further if they don’t.
There were two reports on maternity, both – in different ways – quite disheartening.
Adam Gornall, Clinical Director for Maternity, gave a lengthy presentation in the safety of the service. It wasn’t possible to see the slides, and he rattled through a multitude of statistics at sufficient speed that the detail was very hard to follow. He stressed good outcomes, training, learning, and recognising when things go wrong. He said that SaTH was not an outlier.
A Defend Our NHS supporter flagged up the apparent discrepancy between Adam’s report and the national dataset on maternity outcomes – which showed SaTH as the 4th worst for extended perinatal mortality in a group of 47 trusts, in 2015 and 2016. It may be that the difference is readily explainable – as it depends on whether SaTH was caring for very high-risk pregnancies and babies during this period. But the information on this needs to be made public, because now the national audit of maternity outcomes says one thing and SaTH says another.
The campaigner also asked if he was right to be so confident about the safety of the service, given that the CQC had acted to protect the public two days before. We also had the independent Ockenden Review into over 100 cases of baby deaths or adverse events; a review set to make wide ranging and comprehensive recommendations. Adam was very confident. There were not 100 deaths but 100 cases, the review was investigating the investigations not the deaths, and inevitably people had come forward because they just wanted to ask questions.
Why is this a wee bit concerning? The question was asked by an experienced clinician who worked in the NHS for many years. Her view is that professional self-doubt can be a valuable thing for a clinician to possess.
And the second report was on the continued closure of the rural Midwife-Led Maternity Units in Bridgnorth, Oswestry, and Ludlow. The report was from Head of Midwifery, Sarah Jamieson. Again, the emphasis was on rattling through information from slides that couldn’t be read. Some of the assertions made – particularly on steady decline of rural MLU use – were simply wrong. The ‘engagement’ – taking place many months after closure – showed strong opposition to the closures (346 out of 422 responses) – but the plan was to ignore this.
A slightly snippy debate with a campaigner was cut short by the Chair. This is a fight that has not gone away.
A neat illustration of the idiocies of NHS privatisation popped up briefly in the meeting. SaTH’s Orthopaedic Consultants are running out of work, and in a very few months will be sitting around with little or nothing to do.
Why? Because the NHS is paying those same Consultants to carry out the work at the private Nuffield Hospital! Bizarre, but true. And one to take up with MPs, maybe.
And some final thoughts on the threat to our A&E
1) So why are they doing this?
On the face of it, it’s inexplicable. It’s going to cost over £5 million to close the A&E overnight: £3.4 million in lost ‘business’ for SaTH, and another £1.7 million at least in additional ambulance costs. All that money for a worse service that endangers patients.
The answer became clear later in the meeting, when most members of the public had gone. This is an organisation in financial crisis. They are on target to be £4.3 million adrift of their ‘control total’ agreed with NHS Improvement – and the control total allows for a deficit of £8.6 million. This is before the huge costs of overnight A&E closure! The deficit isn’t SaTH’s fault. This is about national under-funding of the NHS, and a funding formula that penalises small to medium sized District General Hospitals. It would help, though, if SaTH told the truth about this, and asked our MPs to lobby the Government for proper funding.
The Board is worried about the escalating financial crisis. They have a meeting with NHS Improvement in two weeks, and they are anticipating it will be ‘tough’ and ‘awkward’. They believe they’ll end up having to borrow extra money to get them through the year – but this just stacks up more cuts to be made next year.
Spending £5 million on overnight A&E closure only makes sense if it’s a stepping stone towards implementing spending cuts. There is simply no other logical reason for this to be happening. We believe that the ‘temporary’ closure of the A&E at Princess Royal will be in place until Future Fit closes it down altogether. The cobbled together package of quick fixes being put together now will create a dangerous and unstable system – and in six months or nine months, we’ll be told about the additional services that need to be moved from one hospital to the other.
This is simply about implementing the Future Fit cuts and closures early – and doing it to save as much money as they can.
2) There is an alternative
And it’s not ‘special measures’ – because the feedback from around the country is that special measures lead to more cuts and less accountability.
The answer lies in employing locums short-term, as a safer option than closing an A&E. It’s about offering an attractive employment package to staff – and senior doctors have told us about the support and training that would attract more staff, from the UK and overseas. It’s about tackling the culture of bullying that makes SaTH a miserable place to work for so many staff. And we firmly believe it’s about changes at the top. It’s the job of the Chief Executive and the Medical Director to ensure high quality and safe patient care. They’re letting down their staff – and they’re letting down patients.
Five middle-grade doctors are all it would take. NHS England could pick up the phone and sort this out. Secretary of State Matt Hancock could pick up the phone and tell them to sort it out. We’ve written to Matt Hancock and asked him to intervene, and we’re pushing for Defend Our NHS supporters to meet with him. We would welcome our MPs asking Matt Hancock not for ‘special measures’ – but for the doctors and funding that our NHS so desperately needs.
I was at the previous SaTH Board meeting. There was absolutely no doubt that the case was being made that closure was the only way forward. There was no ‘if’, although, of course there had to be a nod towards the practicality of implementation (compromised by the clear assertion, in the presentation, that nothing else was possible as a way forward. I have rarely seen such supine lack of examination of issues by the executive – only one Board Member voted against.