Health authorities have been quick to seize on the news that Andrew Lansley has accepted the Independent Reconfiguration Panel’s recommendation to adopt Health for North East London’s plan for our local hospital trust to reduce health services at King George Hospital and increase services at Queen’s Hospital Romford … but it’s not going to happen yet.
The CQC has demanded that before any changes can be made, a lot of work needs to be done to overcome severe failings in the current health service provision. So serious are these concerns to patient safety that the CQC has imposed emergency measures to move planned caesarean sections from Queens to the Homerton in Hackney; Queens has been restricted to 20 births a day and Kings to 7 and women from Essex will have to re-book with Essex hospitals.
When announcing his decision, Andrew Lansley said: “Patient safety and quality of care must be our top priority. I support the CQC’s findings and the decisions taken by the local NHS to support safe care at the Trust. When we can be sure that these decisions have resulted in sustainable improvements in the quality of services for local people, the next set of decisions … will be implemented.”
Before the Health4NEL’s plan can be implemented, the CQC has told the Trust to develop an action plan to address the 73 recommendations which it has said are needed to ensure a real and sustainable improvement in patient safety and experience. They will then monitor how the plan is applied and progress made before any of Health4NEL’s plan can be activated.
The main problems which will need to be overcome first are:
Maternity is considered the worst concern – poor service culture, staff shortages especially midwives and paediatricians, lack of learning from maternal deaths and incidents, abusive behaviour by some staff to patients and colleagues, lack of leadership by senior management.
A+E unsafe working practices, delays and bottlenecks, struggling to cope with the volume of patients, especially during winter, lack of staff (in July 2011 there was a 31% vacancy of A+E consultants).
Radiology insufficient radiography cover, low standard of work, inappropriate patient facilities due to lack of beds.
Delays in day surgery and radiology treatment affecting the impact of treatment and care.
Staff shortages less than 50% of staff at Queens are permanent, high levels of staff turnover, sickness, recruitment difficulties, high levels of vacancies – in June 2011 there was a 18% vacancy of nurses.
Other problems include poor response to complaints, lack of governance, lack of senior management expertise, lack of education and training, unprofessional behaviour of some staff.
It is unlikely that these problems will be solved quickly. Cynthia Bowyer, the Chief Executive of the CQC said: “We have been forcing the Trust to address issues on a short term basis but we have real concerns about safety in the mid to longer term.”
The biggest obstacle to the implementation of the changes is capacity. Health4NEL’s plan is based upon reducing the number of patients at Kings and increasing them at Queens. However, it is clear that Queens is not coping with its current level of patients, so that the CQC supports a recommendation to permanently cap the number of maternal patients admitted to Queens.
This is why the CQC intervened with its emergency measures to reduce the number of maternity patients at Queens now. Maternity capacity levels are now becoming a problem at Whipps Cross and Newham hospitals, which will need to have additional facilities provided to cope with any increase in maternity patients. Queens capacity problems are also evident in A+E, radiology and day surgery.
To compound the problem, the Trust’s workforce strategy for 2010-2015 states: “To achieve the cost reduction plan the Trust anticipates that the headcount will need to reduce by circa 850 FTE (including temporary staff).” The CQC has found an increase in patient throughput. As this staffing reduction is part of Health4NEL’s case for supporting its plan, it shows a fatal flaw in this strategy.
The one good thing that has come out of all this is that there is formal recognition of concerns which have been dismissed or ignored in the past.
However, the bad thing that has come about is the adverse publicity about Kings and particulary Queens, which will make future recruitment even more difficult.
Once the Trust has been able to demonstrate to the CQC that it has solved its problems on a sustainable basis, the Health4NEL plan can go ahead… but are these problems solvable given the rise in population, lack of finance and staffing difficulties? If they are solvable, how long will it take?