Why Jeremy Hunt made a terrible decision on Lewisham Hospital

On 31 January 2013, health secretary Jeremy Hunt announced he had approved the downgrade of Lewisham A&E to a "smaller" A&E and the downgrade of the existing maternity unit to a mid-wife led unit. Throughout his announcement, he continually re-asserted that his decision was made on the advice of NHS medical director Professor Sir Bruce Keogh.

Many papers and website have inaccurately described this decision as a "partial victory" or a "compromise". This isn't true. The "smaller" A&E is essentially the urgent care centre originally proposed by Matthew Kershaw dressed up in different language. It still would not be able to see serious cases such as meningitis and pneumonia. The mid-wife led unit was the TSA's original recommendation and has been strongly opposed by campaigners from the very beginning. It would mean that, should a pregnant mother go into a seemingly "low-risk" labour (if there is such a thing??) which suddenly runs into serious complications, they will have to be transferred to another hospital to receive the necessary emergency care, rather than being treated at Lewisham as is currently the case.

Despite the Conservative Party's emphasis on "localism" and Jeremy Hunt's own assertion that NHS decisions should be made in consultation with local people and local clinicians, it seems that the entire basis of the health secretary's final decision was "Sir Bruce said...". This is despite the fact that 90% of respondents to the TSA's draft report opposed the Lewisham Hospital proposals, as did all local clinicians.

DUBIOUS STATISTICS

A quick look at the statistic and claims made by Sir Bruce and then regurgitated by Hunt reveals some very dodgy looking stats. Below are the main ones:

1) the changes to maternity and emergency care would result in the average blue light transfer times in south-east London increasing by one minute (by supersonic jet perhaps?)

2) accessing consultant-led maternity services will involve an increase in journey times on average of two to three minutes by private or public transport (an extra 2-3 minutes to travel an extra 6 miles? Really??)

3) the new free-standing, midwife-led unit at Lewisham Hospital will be able to deal with a minimum of 10% of existing activity and up to 60% of current activity (no clinical evidence provided)

4) the new smaller Lewisham Hospital A&E can continue to see up to 75% of those currently attending Lewisham A&E (no clinical evidence provided)

5) the overall proposals could save up to 100 lives per year through higher medical standards (no clinical evidence provided)

SIR BRUCE'S LETTER

There are a couple of interesting points in Sir Bruce's letter to Hunt (which can be found here: https://www.wp.dh.gov.uk/mediacentre/files/2013/01/SLHT.pdf) that make it clear that these proposals cannot go through:

a) "The TSA [a new one will be appointed now Kershaw has landed a cushy job as a hospital CEO] and local clinicians must be able to articulate clear and understandable plans for the public to reassure them that acutely ill patients, particularly from the Lewisham area, will be able to access high quality services in an emergency."

- Well, given that local clinicians are unanimous in their opposition to the proposals, this is pretty much an impossibility, no?

b) "I should make it clear that patients who have a potential to deteriorate ... would not be appropriate for this facility [the smaller A&E]."

- Erm, someone might need to remind Sir Bruce that ALL patients have the potential to deteriorate. As such, surely he's actually confirming what we all know to be true: a smaller A&E simply cannot work in practice.