Dr A Augustine Jenner Health Centre
Dr M V Edwards 201 Stanstead Road
Dr C Lamptey Forest Hill
Dr R M Rowland SE23 1HU
Dr A Sykes Tel: 020 3049 2960
Dr S Van Cooten Fax: 020 3049 2961
Dr A Warsop
Practice Code: G85004 www.jennerpractice.co.uk
Mr Matthew Kershaw 5th December 2012
Trust Special Administrator
South London Healthcare NHS Trust
Queen Mary’s Hospital
Dear Mr Kershaw,
The doctors, nurses, management and administrative staff of the Jenner Practice would like to express our grave concerns regarding the proposals expressed in the TSA draft report ‘Securing sustainable NHS services.’ The first principle upon which the report is predicated is that ‘Patients’ interests must always come first’ (p11.) We are deeply concerned that our patients’ interests, and the quality of medical care readily available to them, would suffer under these proposals, in particular from the proposed degradation of acute services at University Hospital Lewisham (UHL.)
The journey times included in the report appear to be optimistic, certainly for patients in our catchment area, who currently face a single bus journey of 27 minutes to reach UHL (TfL website.) Journey times to other units are considerably longer; according to the same website, King’s College Hospital (KCH) involves a 41 minute journey, and Queen Elizabeth’s Hospital (QEH) a journey of over 1 hour 10 minutes. Patients, and relatives visiting them, would face substantially increased journey times. In addition, these figures reinforce our conviction that, in the absence of suitable admitting facilities at UHL, our patients would elect en masse to attend KCH A & E department rather than QEH, although attendance at the latter appears to be assumed in the draft report. Our ongoing survey of our patients’ preferences supports this contention. Our patients do not feel a cultural affiliation to QEH, they have little experience of it, and are more familiar with travelling towards the city centre rather than travelling outwards, besides the highly extended journey time mentioned above. The consequent additional strain on the already-burdened KCH A&E department (nor, indeed, the additional burden on QEH) does not appear to be addressed in the report, and there is little mention of the financial and time burden imposed upon patients and their relatives through their extended journey times. The ‘blue light’ figures quoted in the report are reassuring, though unsubstantiated. Our knowledge of local road conditions, particularly on the section of the South Circular where our surgery is situated, lead us to consider them optimistic. We are concerned that loss of emergency admissions at UHL could pose a threat to the health of our patient population.
UHL and local primary care staff have worked together extensively over recent years, forming good relationships and workable, effective systems, including vertically integrated clinical pathways to reduce unnecessary hospital admissions, and fast IT links for correspondence and pathology test results. This is partially acknowledged in the report, which cites ‘the excellent leadership within Lewisham Healthcare NHS trust’ (p73), but is in danger of being lost with the withdrawal of acute services from UHL and the inevitable fragmentation of our relationships amongst King’s and the other trusts involved in this proposal. This will lead to inefficiencies , fragmentation of care, increased costs and a period of many years at least for relationships to be rebuilt — these systems do not flourish overnight. It is also difficult to envisage how UHL could, under these proposals, maintain its highly-esteemed status as a training centre for medical students and GP trainees on the local Vocational training Scheme. Locally-trained GPs have proved invaluable in understanding and addressing the health care needs of our local population. The loss of UHL as a teaching resource would be difficult to replace from existing facilities in London, and would exacerbate the problems with future GP recruitment in Lewisham.
The threat to UHL maternity unit is worrying, particularly as UHL has recently striven to produce a high-quality unit which is, in consequence, now extremely popular amongst expectant mothers, who struggle to exercise the choice in maternity provision that they are supposed to enjoy. To deliver 4,000 to 5,000 babies annually anywhere else would mean considerable infrastructure costs which could defray any other savings.
Degrading A&E services at UHL would inevitably produce ‘knock-on’ effects elsewhere within the hospital, and we are concerned, for example, that no mention is made of paediatric or mental health services, or the future of the Ladywell Unit. The report makes no mention of the millions of pounds recently invested in improvements to the A & E buildings at UHL, which stand to be wasted in these proposals.
The TSA report was necessitated due to the financial crisis facing South London Healthcare Trust, and we do not under-estimate the magnitude of the challenge which this crisis poses. However we consider that the entanglement of UHL in the proposed solution is unnecessary, and would inconvenience our patients and detract from the quality of healthcare available to them. The proposals will result in a short to medium term increase in costs, which would be prolonged and exacerbated by the consequent long-term fragmentation of care. Recommendations I to IV in the report together offer a viable financial solution through improved management of the current South London Healthcare Trust, without involving Lewisham Healthcare Trust. We urge you to remove recommendation V from the proposal.
Dr Martin Edwards
On behalf of the doctors, nurses, management and administrative staff of the Jenner Practice.