Email to Councillors setting out why BHRUT is using misleading 4 hour A&E statistics

I wrote to the below to Councillors yesterday, as yet no reply from BHRUT, I will put up anything they send.


Dear Councillors

I present a petition on Thursday about the need to extend King George rather than allow housing on the site, I write today about what I minded to say on Thursday about governance issues at BHRUT and why the plan to review the KGH A&E closure appears a sham. The BBC A&E tracker today shows BHRUT 112 out of 133 trusts for A&E performance at May 2018 (1) The review needs to be published by this September 2018 to lobby central government for more beds, doctors and nurses at King George & Queens. I will seek the petition be referred to Health Scrutiny per an earlier petition of mine which led to a working party chaired by Wes Streeting (2). The working party made some excellent recommendations, as yet no other councils have not adopted them. This needs to change. 

I copy in BHRUT to give them an opportunity to comment before Thursday.

BHRUT Governance points 

a) BHRUT needs to put up real 4 hour A&E waits on their website rather than over report them by mixing them up with other data.

The Freedom of Information report I (3) received today shows a 69.72% A&E wait for King George & Queens, the BHRUT website has a higher figure of 73.85. This is important because the Redbridge working party at page 35  links long waits at A&E with higher mortality rates and longer stays in hospital.


I will seek your support on Thursday for BHRUT to start immediate publication of type 1 A&E waits on their website.

b) The working party mentioned above produced a waiting time for pneumonia diagnosis at January 2017 of 557 minutes, (ie 9.28 hours)  at page 35. Via a Freedom of Information request I got the following information for February 2018 (4)

“Average Time 664 to receive diagnosis pneumonia (mins) Average Time 673 to receive diagnosis Sepsis (mins) Average Time 446 to receive diagnosis UTI (mins)”

The average time from being seen by a doctor to a decision being made to admit was 295 minutes for February 2018.

These are shocking figures bearing in mind they are average times, so during peak periods they will be even worse. They bound to be a pressure on mortality rates and for longer stays in hospital. Pneumonia particularly stands out at more than 11 hours. 

However, BHRUT backed away from the February 2018 figures today to say in the Freedom of Information request (3) of 19th June 2018 to say :

"data previously provided was not validated or an accurate reflection of the request. The search parameters used to respond previously were based on patients presenting at ED and therefore different from what was required. Please accept our apologies for the misunderstanding of the initial request. We are therefore unable to provide this information." 

BHRUT continue to provide critical care beds occupancy rates.

I will seek your support on Thursday for BHRUT to provide accurate information about this key information connected to mortality risks and to start immediate publication of life saving critical care bed occupancy rates.

c) Neither the BHRUT Chair or Chief Executive provide written reports, instead preferring purely verbal reports. This is an obstacle to transparency and accountability. For example at the June 6th BHRUT board meeting Matthew Hopkins give a verbal report concerning a fire at Queens. This was covered in the press (5). However, Matthew provided more information in his report to say that the fire led to “limited disruption” & “ambulance divert” and smoke in child areas. A fire of this magnitude deserves a written report as to the likley causes and to what is happening to prevent it happening again.

I will seek your support on Thursday for BHRUT to provide written reports by the Chair and Chief Executive in future.

d) When attending the BHRUT board meeting earlier this month I got the impression that Matthew Hopkins thought the plan to close King George A&E was still the way forward and to challenge the plan was "futile". For longer than I can remember I have called for these important board meetings to be recorded to allow fair reporting of what is said. Joe Fielder declined my request yesterday to allow recording of the meeting claiming it led to too much "pressure" on board members. NHS England record their meetings and has not impeded their work. Matthew disputes my interpretation of what was he said.

I will seek your support on Thursday for BHRUT to record and broadcast their board meetings

Why the November 2017 review into the King George A&E closure appears a sham
I quote from a press article from last year:

"Jane Milligan, ELHCP executive lead... added: “Our east London population is growing and ageing, demand for NHS services continues to increase, and we face ever-increasing challenges as a healthcare system.
“We now need to consider more options for the way we deliver urgent and emergency care across our communities.
“This will allow us to look at how this care is provided locally, taking these challenges into account.
“It is important we consider how we deliver these services across both King George and Queen’s hospitals to enable us to deliver care in the best way for patients. Exploring more options will enable us to do this.”
Ms Milligan called on clinicians, patients and partners to come together to develop a new plan for emergency care across north east London.
She added that while this new plan was being consulted and drawn up, King George Hospital’s A&E would remain open.
Chief executive of the Barking, Havering and Redbridge University Hospital Trust which runs both King George and Queen’s Hospitals, Matthew Hopkins, was also happy with the news.
He said: “I’m pleased we now have the opportunity to work with our clinicians, our wider staff groups, patients and partners to look at the best way of delivering urgent and emergency care to local people.” (my emphasis)
My reasons for why the November 2017 review are a sham are as follows
1) No options have been published
2) No consultation process has been published
3) No publication date has been published
4 The 2016 BHRUT clinical strategy which includes closing King George A&E is still up on the BHRUT site here file:///C:/Users/User/Downloads/Clinical-Services-Strategy.pdf lists at page 7 the aim of closing King George A&E. This begs the question of why is it still there if a new plan is meant to be delivered in the near future?
5) The BHRUT board used to alternate their board meetings between King George and Queens to show their commitment to King George.However, the current BHRUT meeting schedule has only 3 out of 10 board meetings to take place at King George. This appears to be the board distancing themselves from King George continuing as an acute hospital taking emergency admissions. Such a distancing cannot be a good recruiting tool for encouraging A&E staff to come to King George, nor can it encourage Queens A&E staff to stay for fear of unsustainable workload coming their way. I have been chasing the board to make a statement on why the board has decided to distance themselves from King George for weeks. Joe Fielder, the BHRUT Chair give me a commitment at the board meeting that I would get an explanation for the change by close of business Friday 8th June. I am still waiting for this answer and another answer to a question about whether the board accepts the need for more critical care beds at King George.

Before the 6th June meeting, BHRUT wrote to me to say a:

"shortage of suitable rooms at KGH because they had been booked out, in advance, for educational purposes.
In the future it remains our intention to hold an equal number of meetings, where practicable, at both sites."

Which is unacceptable and so prompted me to ask the question in public as if BHRUT were committed to meeting at King George, a way could be found, even if it meant using a part of the King George canteen to meet in.

I look forward to presenting the petition on Thursday. The points above are aimed to help discussion about how we can extend King George, something we all want to achieve.

With regarding stopping housing on the site, I will make the argument for Redbridge checking out whether the NHS claim that King George land is really surplus land is and that the Council should set a working party to consider the best NHS hospital site for expansion in North East London for the new emergency admission beds required to cope with the huge increase in population planned.

Regards
Andy
(1) BBC NHS tracker https://www.bbc.co.uk/news/health-41483322
(2) Redbridge working party here  http://moderngov.redbridge.gov.uk/documents/s113032/BHRUTEDScrutinyWGoutcomereport-final.pdf
(3) BHRUT Freedom of Information request of 19th June 2018. 19th June Freedom of Information Request
  1. BHRUT Freedom of Information request showing waiting times for February 2018 Freedom of Information Feb 18
(5) Queens Fire at http://www.romfordrecorder.co.uk/news/staff-went-above-and-beyond-to-minimise-impact-of-fire-at-queen-s-hospital-1-5517233 you may find it interesting that BHRUT are moving away from talking about patients to customers.

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