Lewisham Hospital: Paying for PFI

Submitted by Matthew on 14 November, 2012 - 7:58

The South London Trust Special Administrator report takes some wading through but it turns up some scary facts.

Lewisham Hospital is set to become a centre that deals only with some elective procedures, and minor injuries such as fractures.

The Administrator says that if Lewisham Hospital provides planned non-complex surgery, such as joint replacements, and does not have to deal with emergency cases, uncertainty about the timing of surgery would be reduced.

Planned surgery is sometimes delayed because of emergency cases. But even routine elective surgery can be unpredictable, and emergencies are not the only reason for delays, e.g. surgery can turn out to be more complicated than expected,

Having elective (planned) surgery won’t solve the whole problem. It would also de-skill staff, by not exposing them to the more complex cases, and is not as good a use of the facilities and expertise that currently exist.

The idea is that specialist centres are safer. In such centres staff have dealt with a larger number of similar cases (and become more practised). But more variety in the workload means that individuals have a greater range of skills. And in a world where patients are getting older and have numerous comorbidities (different health conditions) this can be an advantage.

However if something goes wrong at Lewisham under the plan, and there’s no ITU, and no emergency staff to deal with it onsite, the patient would have to be transferred to another hospital.

This is one of the reasons why patients receiving treatments privately often end up coming to the NHS. They have complications which private hospitals are not equipped to deal with.

The document quotes a study that says that patients are more likely to die if they’re treated out of hours. This may be because there are fewer senior doctors on site.

It therefore proposes that consultant services are only provided on four sites rather than five, and not Lewisham.

But a lack of junior doctors, pharmacy facilities, and general diagnostic and practical equipment is also a significant out-of-hours risk factor. I have run from ward to ward (because there’s been only two porters on site out-of-hours), abandoning my patients, pursuing a doctor with drug chart in hand, as the only way to get the prescriptions my patients need.

4,400 babies are born every year at Lewisham Hospital.

The service is over capacity, and there is no spare capacity in the surrounding area. Midwives say they sometimes have to send women in labour as far away as Hammersmith in West London to get a bed. This situation would become much worse if Lewisham’s maternity services were shut or reduced.

There is an option of having a “stand alone” obstetric service at Lewisham. By “stand alone” it means this would be without the ITU or A&E departments. Is it safe? A maternity unit that does not have the facility to provide caesarian sections would mean women in labour, where there are unforseen complications, would have to be transferred by ambulance to another Trust.

Without A&E or emergency surgery many of the medical wards at Lewisham would shut.

The full consultation document is 87 pages. It is not available in libraries or GP surgeries, and has not been mailed to people.

The South London NHS Trust “overspent” by £65 million in the last financial year (2011/2012).

However, the Trust currently spends £69 million each year to maintain its PFI contracts at Princess Royal University Hospital (£35 million) and Queen Elizabeth Hospital (£34 million). The report recommends the Department of Health provides an annual payment of £25.1 million towards the cost of the PFIs.

So even if the recommendations are accepted, the Trust would have to continue paying £44 million per year just to use its own buildings!

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