Dear Mr Kershaw
The Lewisham ENT consultants have been following the developments concerning the South London Healthcare NHS Trust for the past five months. We note the need for action and have read your draft report which proposes radical change. There were no references to ENT services, but the proposals for re-structuring would impact considerably on ENT services across all hospital sites.
The thrust of the draft report comes as an enormous surprise. Shutting down an Acute Trust which has managed to successfully address its affairs both on patient qualitative parameters, and of course the all important financial targets, would seem imprudent. Yet the conclusion of the TSA report is that the Trust that has repeatedly failed financially will retain most of its services as they currently stand, and in addition will enjoy the writing off of its debt, with a favourable moderation of its current PFI going into the future.
Of course the preamble is not necessary as you are fully aware of your own proposal, however it serves to illustrate our own reading of the issues and we hope that you understand our incredulity at these proposals. Also we note that regrettably the opinions of clinicians involved in the initial consultation have been ignored. We have grave reservations about your management demand assumptions, especially concerning care in the community and the totally un-realistic A&E flows, all of which casts serious doubts in our minds about the realism of your proposals. Finally the assumption that neighbouring Trusts would hand over their elective surgery is, at best, wishful thinking.
We are very keen to cooperate with you through collaboration to reach the right decision for our service, and we wish to point out some issues in connection with our service.
The ENT Department at Lewisham is staffed by 7 consultants and provides the full spectrum of ENT to a population of over 700,00. It may not have been obvious to you but we also serve the populations of Greenwich and Bexley through outpatient clinics at the Queen Elizabeth Hospital and Queen Mary’s Hospital. All operating has been centralised on the Lewisham site for over 40 years.
We see and treat approximately 3000 surgical episodes and 20,000 out-patients per annum across three sites, i.e. QMHS, QEH and UHL. Nearly 90% of our patients needing surgery are treated as day cases. ( Our targets are regularly met, both quantitatively and qualitatively.). Our service, like most others, has important co- dependencies with other departments both clinical ( e.g. paediatrics, anaesthesia) and allied (pathology, radiology etc). This serves to illustrate the importance of careful planning when proposing to move any one of the components.
The configuration you are proposing puts us in a very difficult position . Moving to Queen Elizabeth would need significant extra capital investment to “create” a new department with its associated infrastructure, and of course associated difficulties in transferring clinical expertise both in terms of doctors, nurses and other ancillary services. It is hard to see how this can be justified in this time of austerity. A move away from Lewisham would also be counterproductive as it would remove a large volume of work, nearly 3000 cases, currently done at Lewisham which would fit with the proposed “elective” model for the site.
Essentially what we are saying is that a merger between UHL and the QE seems on the face of it a sensible way forward but how we reconfigure the services within this new trust ought to be left to the clinicians and local managers to decide. In addition it would also seem sensible to consider an amalgamation of the two ENT units on the patch – ours and a smaller 3 Consultant unit at The Princess Royal in Farnborough. This fits in with the need to maintain quality of care and of course to enhance efficiency whilst reducing costs.
Therefore our proposal is for Lewisham to house a combined in-patient unit covering both elective and emergency work, with the Princess Royal Hospital doctors and other staff joining in a single on-call rota. This would have several benefits. First, there would be savings in terms of expensive theatre equipment currently duplicated on each site (LHT and PRU). Second, the number of junior doctors needed to comply with working hours regulations would be more easily managed than the current arrangements. In addition their training would be enhanced by more exposure to consultant expertise in a larger unit. Finally a larger unit would allow even more sub-speciality developments with consequent quality benefits to our patients, and less need for tertiary referrals.
This model would not alter the current out-patient services, especially at the QMS site, and indeed may include some innovative community facilities which a larger unit might be able to provide. Our aim should be to retain if not increase our market share by providing a local service which is already recognised for its excellence. .
Clearly you have had to come up with a solution to the failing trust (SLT) at short notice. However you have not had a chance for any discussions with the ENT departments on the patch to inform your proposals. We are sure that the same comments will apply to a number of other areas such as Critical Care which has already been highlighted eloquently by John O’Donohue. Therefore we do not feel able to support your current proposals as in our view , this would have an adverse effect on ENT services as well as other services for the population of Lewisham, Greenwich and Bexley.
As stated earlier we are not against a merger of LHT and QE, but this can only work if clinicians are at the heart of the decision-making and implementation of such a momentous reorganisation within the newly formed Trust should the decision be ratified. As it stands the present proposals have been ill-thought through and hastily compiled whilst ignoring the valid concerns of numerous clinical bodies. The plan is a recipe for prolonged problems and is a retrograde step in trying to improve services to the local community while cutting costs.