The campaign to save Lewisham Hospital’s Accident and Emergency Department have organised a march to object to the SLHT Administrator’s recommendation to close it to help sort out financial issues at the South London Healthcare Trust, which includes our local Queen Elizabeth Hospital.
Why should we be concerned? Well apart from the effect on the health of people living near Lewisham Hospital who will have to travel much further if they need emergency medical help, and apart from the outrageous unfairness of closing a facility in a financially stable hospital to solve a problem elsewhere, and apart from the real terms reduction of the health care budget for south-east London and the flawed consultation process it will also add to the pressure on Queen Elizabeth A&E and increase the waiting time for patients there.
The proposed closure of the Accident and Emergency Department at Lewisham Hospital has provoked the most concern of the proposals in the 373 page draft document from the Office of the Trust Special Administrator (TSA). The document was supposed to address the budget problems of the South London Healthcare NHS Trust, which includes our local Queen Elizabeth Hospital, but has instead addressed the south east London health system as a whole. A campaign to save Lewisham A&E has been started and has held its first meetings; it is organising a “Link Hands Round Lewisham Hospital” protest event to be held on 24th November meeting at 2.00pm in Loampit Vale. A petition supporting Lewisham A&E and maternity services has been started by MP Heidi Alexander. It currently has over 12,000 signatures, and the number is increasing by hundreds every day.
The TSA proposals have been well covered by mainstream media such as BBC News, and local bloggers such as Transpontine, 853 and the Blackheath Bugle. The Bugle includes guidance on how to answer the sometimes leading and sometimes misleading questions in the TSA online response form. For example Question 13 doesn’t explicitly ask if you are in favour of the closure of Lewisham A&E, rather:
Q13. How far do you support or oppose the proposed plans for delivering urgent and emergency care in south east London? The following shows how urgent and emergency care would be delivered:
Emergency care for the most critically unwell – King’s College Hospital, Queen Elizabeth Hospital, Princess Royal University Hospital, St Thomas’ Hospital
Urgent care – Guy’s Hospital, Queen Mary’s Hospital, Sidcup, University Hospital Lewisham
I’ve tried to read the TSA report, but it’s very hard going, full of acronyms and terms that are meaningful to NHS insiders but not to others. It’s disappointing because as a numerate, reasonably well educated person I expect to be able to understand such documents. It’s also full of bean-counter management speak – I lost count of how many times the phrase “financial challenge” was used – and totally based on the concept that the NHS is a market with hospitals represented by a profit and loss account and expected to return a surplus of 1% of their budget each year. Why on earth would a hospital have a surplus – to give it back to George Osborne? And how can a hospital accumulate debt from year to year – the only way it can pay it back is by reducing its spending on treating patients. It’s the kind of approach Michael Sandel criticised in “What Money Can’t Buy: The Moral Limits of Markets” – wider questions aren’t considered, and for a national institution like the NHS, which is part of some of our most painful and saddest and sometimes most joyful experiences, an analysis that considers the beans more than the humans is incomplete.
The data tables in the report contained a few facts that I haven’t seen mentioned elsewhere:
The TSA is proposing cuts in the numbers of doctors and nurses in the South London Healthcare Trust hospitals – on page 51 it proposes cutting 140 out of 862 doctors and £14m out of the £98m budget for nurses pay. By my reckoning this equates to about 320 nurses losing their jobs, based on the headcount in the Trust’s latest accounts. The accounts also show that they had lost 144, or 6%, of their nursing staff between 2011 and 2012.
The health budget for south-east London seems to be decreasing in real terms over the next five years – at least that is my reading of the table at the bottom of page 37 – at the same time as the population is expected to grow by 6%. The annual increases on the £3 billion budget are less than 2% a year – less than the rate of inflation and with no allowance for population growth. This when the government has pledged to increase health spending by 1% a year above inflation.
The income that hospitals receive will decrease each year as a result of a government imposed nation-wide “tariff deflation” of about 1 to 1.5%. The tariff is the amount the hospitals receive for each admission or medical procedure and they are expected to improve efficiency each year to cope with this reduction in their money.
The justification for recommending Queen Elizabeth Hospital gets an extra £12.2 million a year towards its £33.7 million PFI costs seems to be that QEH spends 16% of its budget on PFI contracts compared to a national average of 10.3%. So the additional money brings the cost to the national average percentage.
I was slightly surprised that health budgets are decreasing – my understanding was that efficiencies are needed because health service inflation is higher than RPI inflation, but I thought that money saved from efficiencies would be used to compensate for this excess inflation. Apparently not – there seems to be less money each year for the next five years.
Another big surprise was the report’s findings about how closing Lewisham A&E would affect the time it would take patients to get to an alternative Accident and Emergency department. It says on page 68:
173. The proposals for emergency care outlined in this draft recommendation would increase the journey time to reach an A&E across south east London by an average of approximately 1 minute for those in an ambulance, 2 minutes for those using private transport and 3 minutes for those using public transport.
Three minutes extra using public transport – I just don’t believe it. Admittedly the report does hedge its bets on travel time – on page 69 it says that public transport travel time for Lewisham residents would be 40.8 minutes, whereas on page 25 of Appendix H it says the incremental travel time from Lewisham to Queen Elizabeth Hospital is 37 minutes by public transport with no traffic.
Overall the impression given by the report is that it is trying to justify its chosen option for the future of the health service in south-east London. The appointment of someone to manage the merger of Lewisham Hospital with Queen Elizabeth before the consultation has completed doesn’t give confidence that our comments will be listened to.
Ploughing through various turgid documents about NHS funding made me wonder how the £105.9 billion NHS budget is distributed to the different areas and hospitals – how is it decided that the NHS in south east London should have £3 billion to spend? Google wasn’t my friend, so I contacted Her Majesty’s Treasury, who replied within a couple of hours saying that I would need to contact the Department of Health for details of the method used to distribute the NHS budget, but pointing me to two documents that might help explain NHS funding.
The first document was A Junior Doctor’s Guide to the NHS, which included the diagram to the right. The DH is the Department of Health, SHA is Strategic Health Authority – in our case London SHA – and PCT is Primary Care Trust – for us this is Greenwich PCT, which controls the budget and commissions services from the NHS Trusts, such as the South London Healthcare NHS Trust that this whole thing is all about. I assume there should be a blue line showing money flowing to the NHS Trusts. I know this is a gross oversimplification, just from the list of different organisations in the TSA report, but it gives the broad flow of money to the hospitals.
Of course it’s already out-of-date because the PCTs will be replaced by GP-led CCGs – Clinical Commissioning Groups – under the current government’s NHS reorganisation.
The second document was the Department of Health Annual Report and Accounts 2011-12 – 230 pages of figures and bean-counter language. However it does include some information about how the NHS budget for different regions (and countries) in the UK is decided. It says on page 61:
A weighted capitation formula determines each PCT’s target share of available resources, to enable them to commission similar levels of health services for populations in similar need, and to reduce avoidable health inequalities. The formula calculates PCTs’ target shares of available resources based on PCT populations adjusted for their age distribution, additional need above that accounted for by age, and unavoidable geographical variations in the cost of providing services.
So broadly it’s based on the number of people who live in an area, how old they are and any special needs – this sounds very like the “health needs target index” mentioned in Appendix H of the TSA report (the Health and Equalities Impact Assessment – scoping report). But it doesn’t say how these factors are taken into account in the distribution, and it only goes to Strategic Health Authority level, i.e. it gives the budget for London but not south east London. Interestingly in 2010/11 the budget for each person in london was the highest in the country at £2163 per person per year.
I’m still waiting to hear from the Department of Health – they give themselves 18 working days to respond to any questions.
The elixir Gallery run by Verve Arts at the Queen Elizabeth Hospital is one of my regular destinations when I’m near the hospital: I’ve seen some impressive photography exhibitions there. The current one is no exception, a selection of 30 of the photographs submitted to the Green Chain Captured 2012 competition. It runs until 2nd September 2012 and is worth a look.
On my way through the hospital I noticed the restored Fever Bell from the former Brook Hospital in an outside courtyard, which, a notice informed me, was “rung to warn local people of epidemics of fever such as measles, scarlet fever and chicken pox”. Intrigued, I had to find out more … and that led me to a fascinating story about the development of health care through the nineteenth century.
Healthcare before public sanitation, clean water supply, an understanding of disease transmission, antibiotics and the NHS was pretty grim, and exacerbated by poverty and poor nutrition. The nineteenth century was blighted by regular epidemics – influenza, cholera, typhoid, scarlet fever, measles and more – killing tens of thousands of people. Life expectancy for the poor and unemployed was as low as 15, and only 35 for the better-off, with as many as 66% of the children of labourers and servants in northern cities dying before the age of 5. For the old, infirm and poor the Work House was the main source of health care, and their carers were often untrained paupers who were themselves living in the Work House.
Following a campaign by, amongst others, Florence Nightingale, the Metropolitan Asylums Board was set up in 1867 to take over some of the responsibilities of the Work Houses for health care. The MAB established hospitals to look after people with smallpox, fever and insanity, and opened the Brook Hospital on 31st August, 1896 as part of its response to a scarlet fever epidemic in 1892/3. The hospital was built on the pavilion principle promoted by Florence Nightingale, like the nearby Royal Herbert Hospital, and included wards dedicated to scarlet fever, enteric fever (typhoid) and diphtheria as well as isolation wards. I couldn’t find out anything about the fever bell, but as there had been public unhappiness about outbreaks of smallpox near MAB smallpox hospitals, maybe it was felt necessary to warn local people about new epidemics.
At the start of the First World War the Brook was taken over by the military and it became the Brook War Hospital in 1915, with twice as many beds crammed in. During WW1 over 30,000 military personnel were treated at the Brook. In the second world war it became a general hospital, treating both military casualties and civilians. It was bombed a number of times during the blitz, according to David Lloyd Bathe’s “Steeped In History”, the most serious being on the 11th November 1944 when a V2 rocket attack destroyed the top deck of a bus and the nearby ambulance station as well as damaging the hospital. An alsatian rescue dog named Thorn assisted in freeing survivors trapped in the hospital. Thorn was a direct descendant of a little puppy rescued in a WW1 trench called Rin Tin Tin and was awarded the “animals’ VC”, the Dickin Medal, for one of his other rescue missions.
The Brook was taken over by the London County Council in 1930 when the MAB was dissolved and then it became part of the NHS in 1948. It was closed in 1995, when the Queen Elizabeth Hospital opened, and redeveloped as housing. The only buildings remaining from the hospital are the water tower, entrance lodge, administration block and steward’s house. The 130ft high water tower, which could hold 20,000 gallons, has been converted into luxury self-catering accommodation which can sleep up to 10 people. It still seems to be available for the Olympics, though it will cost £7,500 for a week.
The hoardings around the former Cottage Hospital on Shooters Hill have come down, revealing a restored and spruced up Queen Anne style house where not so long ago there was a boarded-up, vandalised wreck. Like other nearby historic buildings such as the Police Station and the Royal Military Academy, the Cottage Hospital has been transformed into housing by combining a converted and restored old building with new houses and flats. The picture at the top shows how it looked in its heyday, and that at the bottom how it is now – post-restoration and conversion.
I love maps, especially old ones, so it was fascinating to see the history of the building illustrated in a sequence of 6 maps from 1869 to 1991 in a “map regression” presented by developers Turnhold in their Supporting Statement for the planning application. The maps clearly show the hospital develop from its original T shape with the addition of wings and annexes over the years. The statement also contains an interesting set of photographs of the building before it was restored. The early history of the hospital is described on the Lost Hospitals of London website:
The Woolwich, Plumstead & District Cottage Hospital was founded in 1888 by Mr. William Woodford, who remained its Honorary Secretary until 1912.
A half-acre site on Shooters Hill was leased from the Secretary of State for War in December 1888 and the foundation stone for the building was laid by the Duke of Cambridge in September 1889.
The Hospital opened in November 1890. The 3-storey building contained 12 beds, two of which were reserved for private patients.
By 1912 the Hospital had 12 beds and 2 cots. Schoolchildren referred by the LCC for removal of tonsils and adenoids accounted for a great number of admissions. The Hospital also undertook herniotomies and minor operations. Out-patients were also seen, although there was no formal Out-Patients Department.
The Cottage Hospital buildings stopped being a hospital in 1928 when patients were transferred to the newly opened War Memorial Hospital further up Shooters Hill.
English Heritage have recently released a draft of Volume 48, Woolwich, of their Survey of London. This is an excellent read for anyone interested in local history, and covers the story of Woolwich in marvellous detail. It’s a pity it doesn’t cover more of Shooters Hill, but Chapter 10 does bring the story of the Cottage Hospital up to date:
The cottage hospital was adapted as a training school and home for nurses. After subsequent use as a carpenters’ workshop, in 1962 Bexley Hospital extended and reopened the premises as Castlewood Day Hospital. Final health-service use in the 1990s was as the Signpost Castlewood Centre, for the rehabilitation of teenage drug-users. Turnhold Properties acquired the disused hospital and, after a period of dereliction, the buildings were converted in 2011–12 for Family Mosaic, a housing association, with the Hill Partnership as developers and contractors. Forge Architects supplied designs, with details and subsequent work by Saunders Boston, architects. The result was Castlewood, a complex of five flats and six houses incorporating a new pale-brick terrace to the rear, of two and a half storeys.
So the building’s name is now Castlewood, presumably because it was once the Castlewood Day Hospital. Not to be confused with the mansion named Castlewood, shown on 1914 and earlier maps, which once stood in Castle Wood to the south of Severndroog castle, or another former mansion, Castle House, home of Major Charles Phillips who donated the land for the War Memorial Hospital.
I wandered up to the elixir Gallery run by Verve Arts at the Queen Elizabeth Hospital while waiting for an appointment this morning, and was totally (but pleasantly) gob-smacked by the exhibition of infrared photography by Andy Linden that is currently on display there. A poster by the exhibition describes it:
Andy Linden is a member of the Aperture Woolwich Photographic Society, he has lived in the local area all his life and been a photographer for 30 years. He is also a member of the Royal Photographic Society and gained the distinction of Licentiateship (LRPS) in 2009.
All the pictures in the exhibition were taken using an SLR digital camera that has been converted so that it is sensitive to the infrared (non-visible) part of the spectrum.
Leaves and foliage strongly reflect infrared radiation, so they usually appear bright in an infrared photograph. The majority of these pictures were taken in and Greenwich Park and the surrounding areas. They have been post-processed in Photoshop to produce the tones that appear in the final prints.
One of the delights of the Memorial Hospital is the stained glass that decorates some of its corridors and stairways, and the St Nicholas Chapel. I was lucky recently to have the opportunity to take some photographs of the windows, which I have put on the flickr site. Most of the topics depicted in the windows need no explanation; a view of Eltham Palace, Henry VIII’s Great Harry ship which was built at Woolwich and the religious subjects in the chapel. However I found one window, shown above, puzzling. Who was William Fisher, I pondered, and what was his connection with the area?
Google wasn’t my friend on this occasion, and couldn’t answer my questions. So I headed down to the local history section of the Woolwich library and the trusty W.T. Vincent’s “The Records of the Woolwich District”. Vincent talks about the visit of Queen Bess to Plumstead in July 1573, but names her host as Thomas Fisher rather than William. He describes Thomas Fisher as having been a clerk or bailiff who was employed by Sir Edward Boughton in the management of the king’s estates, Sir Edward having been granted “the manor and parsonage, tythes &c., within the parishes of and villages of Plumstead, Bostall, Wickham, Welling, Woolwich, Bexley, Lessness, Erith and Yard, alias Crayford” by Henry VIII after the dissolution of the monasteries. Vincent goes on to say of Thomas Fisher:
The old historian, Dugdale, represents Fisher as being:
“As greedy of church lands as other courtiers were,”: observing that “he swallowed divers large morsels, whereof Bishop’s Itchington was one; he made an absolute depopulation of that part called Nether Itchington, where the church stood (which he also pulled down for the building of a manor house in its room); and to perpetuate his memory changed the name of it to Fisher’s Itchington”
He also had a manor house in Plumstead , and much of the land in the parish which had been seized by the late King Henry had apparently come to his share. He was pretty well to do, and on the occasion of the royal visit he presented her Majesty with a ball of gold, with a cover, having a lion standing on the top, crowned and holding the Queen’s arms.
Vincent thought that Fisher’s home was the Old Manor House in Wickham Lane, also known as the Pilgrim’s House or Wolsey’s House.
A Google search for “Fisher’s Itchington” threw up Thomas Fisher MP, who according to wikipedia was MP for Warwickshire and was the person who depopulated Nether Itchington, but no connection with Plumstead or Woolwich is mentioned. So a partial solution to the mystery ….
Gold connections continue in some of the other stained glass windows at the hospital.
The Henry Grace à Dieu, also known as the Great Harry, was the first ship built at Woolwich Dockyard, and the reason the dockyard was founded by Henry VIII in 1512. It was the largest ship of its time, with many innovations such as having two fully armed gun decks, gun ports and 21 of the new heavy bronze cannon. As the window says: she conveyed Henry to the summit with King Francis I of France at the Field of the Cloth of Gold and ended her life at the start of Mary’s reign in 1553, when she caught fire and sank at her mooring at Woolwich… “by neckclygens and for lake of over-syth,” according to Henry Machyn.
The peaceful St Nicholas chapel at the Memorial Hospital opened in 1986 after the closure of the St Nicholas Hospital that was situated in Tewson Road, Plumstead. One of the windows in the chapel is known as the Golden Window, and illustrates the text “Suffer little children to come unto me”. According to the Lost Hospitals of London web site:
The ‘Golden Window’ was originally installed in 1956 in the Hospital chapel at Goldie Leigh Hospital. It was moved to the Memorial Hospital chapel and rededicated in December 1986.
That was all I could find out about this window, but I’ll add it to my list for the next time I’m in the library at the Heritage Centre.
What a range of interesting local history was encapsulated in just three windows!