AFTER the announcement on the future of hospital services in outer south east London, LINDA PIPER looks at the facts and figures and the implications of the decision.

MICHAEL Chuter, chairman of the Joint Committee of Primary Care Trusts, says a decision on reconfiguring hospital services had to be made on clinical grounds.

Mr Chuter says none of the four hospitals in Bexley, Bromley, Greenwich and Lewisham is currently meeting all of its minimum clinical guideline standards and would never be able to do so if services remained the same.

Mr Chuter said A Picture of Health had looked at retaining Queen Mary's as a full acute hospital in preference to one of the other three hospitals.

But he said the Sidcup hospital would need to be extended to provide more acute beds and has a high backlog of maintenance.

Turning one of the private finance initiative (PFI) hospitals into a borough hospital would create large amounts of unused facilities which would still have to be paid for under long-term contracts.

He said the extra cost of retaining Queen Mary's as an acute hospital under those circumstances was more than £358m spread over 35 years.

But, when questioned by Bexley resident Iain Coombs, he could not say what proportion of this cost was to prop up the PFI hospital.

Urgent care centres

INTERMEDIATE care beds and rehabilitation beds would be provided at Queen Mary's to relieve pressure on acute beds at the other three hospitals.

Once a patient no longer needs acute care, they would transfer to Queen Mary's, to the proposed new Eltham Community Hospital or beds at the Beckenham Beacon, for their recovery.

A Picture of Health is expecting between 40 and 60 per cent of A&E patients to be treated in future in the new urgent care centres at each of the hospitals.

Day surgery will be retained at each of the hospitals which, it is claimed, will prevent people choosing to use hospitals outside the four boroughs and bring in £10m of revenue to the four hospitals over a year.

It will also considerably reduce the extra travelling time for patients who would otherwise not have been able to use their local hospital.

Talks are about to start with Transport for London and other providers about improving public transport links to the reorganised hospital services.

Option three not feasible

PROJECT team member Jon Schick said option three - reducing emergency services to just two hospitals - would have meant finding 400 extra acute beds at hospitals outside the four boroughs, 270 more beds at the Princess Royal in Farnborough and the Queen Elizabeth in Woolwich, and reducing beds at Sidcup and Lewisham.

Under the chosen option two, A Picture of Health says the bed shortage will be 13 at Woolwich and some maternity beds at King's College Hospital in Denmark Hill.

It says Darent Valley Hospital, Dartford, will need 57 more beds, Guy's and St Thomas' 43, and King's College 31.

Backing for decision

THE case for reconfiguration was backed by a number of claims about current services.

Peter Coles, an adviser to A Picture of Health, told the joint committee the intensive treatment unit at Queen Mary's Hospital, Sidcup, was unlikely to reach the accreditation standard this year.

  • Three of the four hospitals' paediatric units do not have separate rotas for neo-natal and children's staff.
  • The shortage of staff stretched across the four maternity units means they are each struggling to provide 40 hours of consultant coverage a week, when the recommended level is 98 hours.
  • The Royal College of Surgeons recommends A&E departments have a catchment population of at least 300,000, and preferably 450,000, to enable staff to keep up their skills levels. The four A&E departments involved share a catchment of a million people between them.
  • None of the four hospitals has sufficient consultants or experienced doctors and nurses to provide 24-hour cover across all specialties in their A&E departments.