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Forest Hill GP Dr Jarrett on Trust Special Administrator's Draft Report

Dr Penelope Jarrett, a local GP in Forest Hill provided a briefing to the Forest Hill Society on the TSA proposals for the closure of A&E services at Lewisham Hospital published on the Forest Hill Society’s website on 7th November 2012..

 

This is part of the briefing:

 

The concerns for those of us in Lewisham are the detailed proposals for the Lewisham Healthcare NHS Trust, which is not even part of the SLHT. It should “join with” QEH, and Lewisham A&E should be downgraded to an urgent care centre. A&E itself is not particularly expensive, but patients who are admitted to hospital need emergency surgery, ITU, X-rays and scans...

The TSA suggests developing a centre for elective surgery at Lewishan, but even if you have elective in-patients, critical care services quickly become non-viable. This raises the question of whether is is safe to deliver babies at Lewisham, and so the TSA suggests closing the delivery ward. The future of children's services, which are particularly good at Lewisham, are not clear. The TSA points out that reduced services at Lewisham would mean that some of the land there could be sold off to raise money.

Unexpected consequences would include loss of the GP training scheme, which is based at the hospital. Many graduates of the scheme, such as myself, stay on to work in the area. Typically, GPs train in medicine, surgery, paediatrics, obstetrics and gynaecology, A&E and mental health, so need a hospital site with all these departments.

Lewisham is a very well run hospital, which had a small deficit a few years ago, but it has worked to turn this into a surplus. In the last year they have opened a brand new A&E, costing £12 million, without using PFI. It works well with local GP commissioners and the council, and new collaborative pathways have been developed (e.g. musculoskeletal, memory service). All this is threatened: Lewisham commissioners will not be able to plan services for the people of Lewisham. There is also a real risk that instead of Lewisham Hospital improving the management of QEH, the link could ruin the finances at Lewisham.

 

The report does not contain enough information to convince me that the financial modeling is correct.  Is the TSA is assuming that the 70 people admitted each day to Lewisham Hospital will instead go to QEH?  The report claims it will only take residents of Lewisham an extra 14 minutes to reach QEH A&E by public transport. I think it will take longer.  I do not think that most people would go there anyway: as a GP I have spent the last 6 years asking patients which hospital I should refer them to. Only one person chose QEH!  If Lewisham were to close, I personally would go to Kings.  There are very significant questions about the capacity of Kings or QEH to cope with extra A&E attendances, and indeed with taking on the 4,500 babies that are currently delivered at Lewisham. Obstetric services throughout London are severely stretched, partly due to a huge increase in the birth-rate in the capital (Lewisham, schools are learning about this, as they have to build more classrooms) and partly due to a chronic shortage of midwives. The report says nothing about this, but I have heard many stories about how A&E and obstetrics at both Kings and QEH  are already struggling to cope.

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