Intensive Care Consultants’ response

Dear Mr Kershaw,

We write to you in our capacity as the seven consultants responsible for the Critical Care Unit at Lewisham Healthcare NHS Trust.

Your current recommendations as the Trust Special Administrator for the now dissolved South London Healthcare Trust (SLT) under the Unsustainable Providers Regime will result in the closure of the Lewisham Intensive Care Unit (ICU).

We do recognise the need for change and that the former SLT was in a precarious financial position due in part to two ridiculously unaffordable PFI developments. However, we do not agree with the very specific changes you recommend for Lewisham.

The Lewisham ICU opened in 1968, the first intensive care in a District General Hospital in England. In December 2006 we expanded into a combined ICU and High Dependency Unit (HDU) in a State of the Art facility in the new Riverside building, providing up to 21 patients with their own bay. We have space to allow us to open an additional 3 ICU and 3 HDU beds above current funding and would therefore be able to provide a significant proportion of the critical care workload currently provided within SLT without any changes to our existing floor plan.

The Borough of Lewisham contains some of the most deprived wards in England. Deprivation is known to make severe, complex illness more likely. Despite this, Lewisham ICU is one of the better performing ICUs in the country (www.ICNARC.org).

The standardised mortality ratio (SMR) is the robust measure of the overall performance and quality of care in ICUs in England. Units are scored every six months, with a score of 1 being the average, and a lower number indicating a better than average unit; Lewisham’s ICU always receives a score of less than 1 (the last three scores being 0.8, 0.8 and 0.9). We also have excellent infection control standards with no patients having contracted an MRSA infection this year.

In the simplest terms this indicates that a patient admitted to Lewisham ICU is significantly more likely to get better than a patient admitted to a unit representative of the national standard of care

In the last 12 months Lewisham ICU/HDU has looked after 772 patients at 94.9% capacity, with 34.8% on full life support and 12.6% requiring renal support. Via the Emergency Bed Service, Lewisham’s ICU is a net importer of critically ill patients from all over London.

Your recommendations, Mr Kershaw, result in the net closure of 6 fully funded ICU and 8 fully funded HDU beds in the South East London Sector. No consultation with the critical care community about the impact of losing this vital ICU capacity has taken place. Within Europe, the UK already has the smallest proportion of acute hospital beds allocated to critical care with 3.5 beds per 100,000 people. For comparison, Germany has 24.6 per 100,000 and the US has 20 per 100,000.

Lewisham is the only DGH ICU in London that has been recognised by the Faculty of Intensive Care Medicine (FICM) as of sufficient quality to train the intensive care doctors of the future. The loss of this training provision has also not been consulted on or even considered.

Lewisham’s ICU recognises that prevention is better than cure and provides a consultant intensivist led outreach service that provides daily review, advice and expertise to all the other specialties to help recognise and initiate the prompt treatment of patients who may be deteriorating in the hope that we can stop them needing intensive care at all.

Lewisham ICU conducts regular patient, relatives and staff wellbeing surveys. We receive universally positive responses and these results have been presented at international meetings. The physiotherapists, pharmacists, nutritionists, speech therapists, radiographers, clerks, cleaners, 66 nurses, 9 doctors in training and 7 consultant intensivists who are proud to call Lewisham Critical Care Department their place of work ask you to reconsider your plans. All the hard work over many years of continuous improvement and dedication to helping the sickest patients in the borough of Lewisham will be destroyed.

Transferring critically unwell patients comes with inherent risks, following implementation of your recommendations we fear that the residents of Lewisham will be forced to bear the brunt of this risk and have to travel to receive intensive care treatment possibly outside South East London.

Lewisham residents will no longer have this excellent facility on their doorstep. The most unacceptable aspect of your report is that it will disproportionately hit critically ill patients from the most deprived areas of South East London – the group least likely to fend for themselves or make their voices heard.

Why should costs to the wider health economy be paid for so heavily by the people of Lewisham?

What signal is sent to the NHS as a whole about the reward for striving for excellence?

Yours sincerely,

 

See Lewisham Emergency Departments’ Response

See ENT Consultants’ response

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