13 February 2018
The South East Essex Green Party have written a letter of response to the Mid & South Essex Sustainability & Transformation Partnership, challenging the STP's plans to reconfigure services at Southend, Basildon, and Broomfield Hospitals.
This letter was sent to the Mid & South Essex STP on 10.02.2018.
We are also openly publishing the letter, as present below:
Dear Sir or Madam,
As the local Green Party we have a long-term interest in the provision of healthcare services and Mid and South Essex and have studied the current proposals in detail having read the full 400+ page full pre-business case, and would like to offer our official response; together with some questions we would like to be provided with answers to.
Transfer of Services
We have read that part of the forward plans are to transfer a number of services to the social care sector; however, at present, this sector lacks the necessary resources to take on the extra responsibilities. There is also a lack of financial resources in this sector and there is nothing to suggest extra funding will be made available. In our opinion the plans are short-sighted as they are based around non-existent resources; we fear that this will put patients at risk as services required by some will be unavailable.
Throughout the consultation, there is a huge reliance on pre-hospital care and prevention of attendances. As Southend has the second highest vacancy rate for GPs in the UK at present and the second highest number of GPs due to retire within the next 5 years, why is there such reliance on primary care to prevent hospital admission? What will happen if results are unable to be delivered?
We understand that there is a need to review the current provision and that a combination of an ageing population, shrinking staff base, and many years of underfunding have put the trusts under significant pressure.
We duly note that there is a strong emphasis on cost-cutting strategies with terms such as;
'reduction and restriction of low-value procedures' [from 9:5:2].
As this description is lacking inner detail, we would like a clarification of the following concerns:
• What type of procedures will this include?
• Who decides what is ‘of value’?
• Will this result in older patients being prevented from having certain treatments?
We also note that there is the reference to treatment at Integrated Neighbourhood Hubs;
• Where will these be located?
• How will these be funded?
• How will these be staffed?
Reliance on Technology
We are concerned with what we have read on P136 (P186) with regards to investment in Apps/Self-Care Technology. Our background research has taught us that there are services such as this already being advertised in London on bus stops (i.e.. GP at Hand) as an alternative GP service. We are concerned that signing up to use these services require patients to de-register from their current GP, in order to register for an online service. This process then leaves people without a physical GP.
Are there any plans in place to assist people to re-register with a physical GP if this service did not meet expectations or was no longer suitable for the patients' needs (not all conditions/illnesses etc. are accepted/able to be treated). At present these services are free at the point of use, is there any assurance on this always being the case?
Increasing reliance on such services excludes certain sectors of the population; not all of the older generation (and we are constantly reminded that the problems are due to the ageing population) have access to, nor are comfortable using computers, tablets or smartphones. I am sure that those without direct access would not wish to have to use such a service in the public library. There would also be barriers to accessing services such as this for those with visual problems, learning difficulties and other disabilities.
From a patient perspective, how good a service can really be provided by an App, Skype or teleconferencing? Are those behind this confident that they can provide services in the best interest of the patient via this facility? What is the risk of misdiagnosis when an appointment is not carried out face-to-face? Is this just seen as collateral damage?
There has been emphasis placed on the £118M capital funding that is to be shared between the three sites. However, as this is only available if certain conditions are met and it has restricted uses, it is clearly overshadowed by the £30M annual cuts that are being imposed on each of the three sites.
There is reference to Non-Specific investment in local health care infrastructure, which is stated ‘could be funded in several different ways’ but the plans for consultation do not provide any details on what the funding options are.
Section 9.3 refers to Investments and Value for money; there is reference to unlocking further savings in a number of ways including:
Targeted new services in primary and community care. We would like to know;
• What services are going to be transferred to P&C Care?
• There is reference to ‘up-skilling’ primary care staff, but is this at the detriment to other staff?
We are not surprised to have read that the nance section also makes reference to 'Redundancies in the acute sector' but we would like to know;
• Will these redundancies be voluntary or compulsory? • How many jobs are at risk in their current form?
• What will they be treating?
There is also reference within the nance section to ‘End of Life services and pathway redesign’ what is meant by this; does this mean that patients will be given less (or no choice) in how they spend their final days? The nance chapter seems to be a highly inappropriate area to make reference to such a sensitive topic relating to patients care; reducing our confidence that these plans are purely in the interest of the patients.
Chapter 10 focuses on the clinical assurance behind the decisions that are being taken. There are clearly barriers to the information and understanding in this area, as the information and content of the report was not included in the pre-consultation business case and had to be requested separately.
We are concerned that this does not stand up to scrutiny given that the Eastern Academic Science Health Networks own independent report within the key summary of findings (P4) cites the limited availability of research and published literature relating to the exact model proposes and that as a consequence reliance upon judgements have been made in many areas. We would also ask what assurance can be provided over the true independence of the evidence base used.
Furthermore, as the key summary of findings also acknowledged that any outputs will open to debate, what evidence can then be provided to convince the public that the findings are robust enough to support any decisions based on them?
Given that the published literature review (that has been given a 60% weighting in this instance) is based on some articles that are almost 30 years old, and that not all the published literature is related to the UK specifically, with a higher proportion of published literature used from countries abroad who do not have the same health care system as in the UK. How can members of the public reading this information have the confidence that the decisions based on the clinical assurance will be to the benet of and not to the detriment of the patients of Mid and South Essex?
Our research into the clinical assurance basis for the proposals has raised concerns that there is not a specific local knowledge within the Senate Council; with none of the members being based at the 3 main sites under consideration. The only link to the local area is a GP member of one of the local CCG’s with over 20 other members coming from a wider geographical area.
With a high proportion of the membership coming from more rural - less densely populated areas, they are unlikely to experience the high volumes of traffic and congestion that is common in the areas between the three sites. Why are the decision makers not individuals with experience and knowledge of the local area which changes will impact?
Furthermore, the Senate membership encompasses a broad range of specialism for different fields, but is lacking clinicians from the three sites in question and individuals with direct links to the services under reconfiguration.
Last summer the public learnt that the previous plans to downgrade Southend and Basildon A&E departments were not backed by the local clinicians. The current plans lack details of local clinicians backing them either. Can you provide details and evidence of the which local clinicians are explicitly and wholly backing these plans for reconfiguration?
The reconfiguration of maternity services refers to a Single Centre for High-Risk Births/co-led units at all sites/Level 2 neonatal at all sites. Not all births are complex before they begin; things can change during labour. Would all centres be able to perform emergency C-Sections? Higher staffing levels than at present would be required for the new model post-reconfiguration; would staff recruitment and retention be adequate to meet these requirements?
We accept that the planned HASU, developed in conjunction with local consultants and if fully funded and implemented properly, would be a major step forward for improved patient care and outcomes. However, we are concerned that not all the resources required for delivery of this currently exist within the STP.
With the additional funding only being made available from separate commission funding, (which has not yet been clearly defined) this would suggest that the proposals have been released too soon, and a longer amount of time should be taken over the drafting of these plans and any decision due to be taken in summer 2018 delayed until actually defined plans can be put before the public; for an area that would appear to be the central key area of focus.
Decisions have been made regarding paediatrics despite there being no evidence related directly to the configuration proposals. It has been stated that currently there is less than optimal staff in current configuration, how would this be resolved by the creation of a specialist centre, and post-reconfiguration, would staff recruitment and retention be adequate? The plans state there would be a PAU on each or the three sites but does not make clear the hours these services would be provided. Would there be 24/7 PAU on all three sites?
We have concerns that the plans put forward to public scrutiny are not detailed enough in some areas. One of area of concern in this respect is the arrangements for transporting sick patients between sites. When questions were raised regarding this at a recent public meeting, the panel were unable to provide any detail as to how this would be put in place, who would be responsible for it’s operation, and how this function would be adequately staffed.
A transfer service of the nature proposed would require specialist staff. As the numbers of Doctors and Nurses are already at a critically low level, what assurance can be provided that sufficiently qualified staff can be recruited and retained to allow access the 'specialist care?’ With an ambulance service already failing to fill its many vacancies and respond to even life-threatening calls within an acceptable timeframe, this is clearly not a safe or feasible option. How can the public have confidence that these plans can be safely delivered?
We also feel that plans to transfer non-critical patients bettween sites is dangerously vague. There is a suggestion that there would be a free bus service linking the three sites; however, in many cases, this is going to result in additional journeys for patients. A patient from Benfleet would have to travel to Southend Hospital to subsequently then get a bus to Broomfield. What studies have been conducted to consider the environmental impact on the extra emergency and non-emergency journeys that will occur? Will these services be provided 24/7 or could patients nd themselves being discharged at Broomeld out of hours with no way of making their way home to Shoeburyness?
While we do not wish to be perceived as overly-negative to the plans you have put forward, we are of the overall opinion that current proposals lack sufcient detail to be given our backing or approval as a party.
We do not concur that everything put forward would be solely in the interest of the patients in Mid and South Essex, nor do we believe there has been adequate support from clinicians based at the sites.
We would like to see any decision on these proposals delayed until more concrete plans can be presented to a further public consultation, where we would hope to see substantiated evidence-based detail and support from clinicians; from where we can then form a more grounded and reasoned opinion.
From our observations there is a slack of open publicity surrounding the plans. We have heard reports of staff members within the trust not being aware of the reconguration, and a lack of publicity material available around the hospital, in GP surgeries and other medical and public buildings, giving us concerns that general members of the public are not properly informed on these matters.
At the recent public meeting it was re-enforced several times that “this is not a referendum” which very much comes across that public opinion would not be given the correct amount of weight in the decision-making process.
We hope that this perception is unfounded, and we look forward to receiving your responses to our concerns; hopefully before the end of the consultation period.
South East Essex Green Party.