Lewisham A&E department will be downgraded, health secretary says

BMJ 2013; 346 doi: (Published 31 January 2013) Cite this as: BMJ 2013;346:f699
  1. Ingrid Torjesen
  1. 1London

England’s health secretary, Jeremy Hunt, today tried to steer a middle course between the recommendations of an administrator appointed to solve the problems of a failing south London hospital trust and campaigners who wanted to keep open their local hospital’s emergency unit.

He announced that the emergency unit at Lewisham Hospital would not remain in its present state, but nor would it be closed or turned into an urgent care centre, as originally proposed. Instead it would be downgraded while still retaining cover by senior emergency staff for 24 hours a day, seven days a week, enabling it to provide services to 75% of the patients who currently use it.

However, the obstetrician led maternity unit at Lewisham would be downgraded to a midwife led birthing centre, as proposed.

Hunt was responding to the report of the trust special administrator, Matthew Kershaw. Kershaw was appointed in July last year by the former health secretary, Andrew Lansley, to recommend a lasting clinical and financial solution for South London Healthcare NHS Trust. The trust is losing £1m every week and by the end of this year is expected to have an accumulated debt of more than £200m (€233m; $316m).

Hunt has accepted the broad recommendations of the administrator that South London trust should be dissolved and each of its hospitals taken over by a neighbouring hospital trust.1

However, one of the administrator’s key recommendations was that Queen Elizabeth Hospital in Woolwich form a joint trust with nearby Lewisham Healthcare NHS Trust. The new organisation would have had a single emergency department in Woolwich rather than Lewisham, while Lewisham’s recently refurbished emergency department would be turned into an urgent care centre. This recommendation was met by massive opposition from local doctors and patients.

Having taken advice from the NHS’s medical director, Bruce Keogh, Hunt has decided that it would be in the best interests of patients that Lewisham Hospital retain its emergency unit. Hunt said, “What is in the clinical interests of patients in southeast London has been at the heart of my decision making process, and as a result I have followed clinical advice to keep open the A&E in Lewisham.”

Hunt has accepted the administrator’s recommendation to centralise very specialist emergency care at four sites in southeast London on the basis that this would significantly improve the quality of care and save the lives of up to 100 patients a year. However, he has decided that Lewisham Hospital would retain its ability to admit patients with less serious conditions and would continue to have 24/7 senior medical emergency cover.

Keogh said, “I expect that balance to result in about three quarters of patients currently seen in Lewisham A&E continuing to receive complete care at Lewisham Hospital and about a quarter being transferred for more specialist treatment elsewhere.”

Chris Ham, chief executive of the health think tank the King’s Fund, said, “South London Healthcare NHS Trust has longstanding and serious financial problems, so no change is not an option. But the decision not to accept in full the trust special administrator’s recommendation in relation to Lewisham A&E and the strength of local feeling about this issue show how difficult these judgments are.”

Julia Manning, chief executive of the think tank 2020health, said that Hunt should have followed the administrator’s recommendation for Lewisham Hospital’s emergency unit.

She said, “The recommendations were not a pick and mix list; they were developed to be taken as a whole to stop the haemorrhaging of money out of the NHS and ensure the people of southeast London have the best clinical care possible for years to come. Matthew could no more consider South London Healthcare NHS Trust in isolation than a doctor can consider one symptom without looking at the body as a whole.”

She said that on Lewisham Hospital’s emergency unit Hunt was “sadly delaying the inevitable and costing the taxpayer more.” She added, “It’s all very well intending the A&E to be smaller and focus on older people, but the reality is that people use their local A&E as an alternative to their GP. If it remains open, people will use it as before.”

The dissolution of South London Healthcare NHS Trust is expected to begin in June and will be completed by October. The takeover of hospitals by neighbouring trusts will be subject to approval by the relevant regulators. South London Healthcare NHS Trust has three hospitals: Queen Elizabeth Hospital in Woolwich, Queen Mary’s in Sidcup, and the Princess Royal in Bromley. All three will be required to make the full £74.9m of efficiency savings identified by the trust special administrator.


Cite this as: BMJ 2013;346:f699