No, Jeremy Hunt has not saved Lewisham A&E

Deficit not NHS

I’m putting this online to preempt the inevitable Evening Standard headlines claiming that Jeremy Hunt has today spared Lewisham Hospital’s A&E department.

From his statement today:

On the emergency care proposals, Sir Bruce was concerned that the recommendation for a non-admitting Urgent Care Centre at Lewisham may not lead, in all cases, to improved patient care. While those with serious injury or illness would be better served by a concentration of specialist A&E services, this would not be the case for those patients requiring short, relatively uncomplicated treatments or a temporary period of supervision. To better serve these patients, who would often be frail and elderly and arrive by non-blue light ambulances, Sir Bruce recommends that Lewisham hospital should retain a smaller A&E service with 24/7 senior emergency medical cover. With these additional clinical safeguards, and the impact that this is likely to have on patient and clinician behaviour, Sir Bruce estimates that the new service could continue to see up to three quarters of those currently attending the Lewisham A&E.

So, the new ‘smaller A&E’ would serve up to 75% of existing A&E visitors.

From the TSA’s report:

54) Urgent care services are well established at Guy’s Hospital and Queen mary’s Hospital Sidcup. The TSA recommends university Hospital Lewisham provide these services also, with a view to treating at least 50% of the people currently attending the A&E and urgent care services at the site. This would mean that urgent care services will continue to be available locally and it will also help to minimise the impact on the four remaining A&E departments in south east London.

55) Analysis included in the TSA’s draft report suggested around 77% of university Hospital Lewisham’s current A&E activity would remain at the hospital under this scenario. However, a number of responses to the consultation suggested that this estimate was too high. Therefore, further analysis was undertaken and, based on practice elsewhere in London, a revised figure of 50% has been used for the modelling that underpins the TSA’s recommendation.

So, the TSA’s proposal – to keep Lewisham’s Urgent Care Centre – was estimated to serve somewhere between 50 and 77% of existing A&E visitors, depending on who you ask. The UCC is, according to the hospital website, designed to “see and treat patients with non-threatening illnesses and injuries”.

In addition:

It is proposed that a paediatric ambulatory service is developed as part of the urgent care service at university Hospital Lewisham.

And also:

Older people are also relatively frequent users of A&E services and are more than twice as likely as others to be admitted to hospital following an A&E attendance. Therefore, the proposed changes have significant implications for the continuity of care for these patients. However, older people who would currently present with problems at university Hospital Lewisham could benefit from being admitted to a step-up facility

So: the TSA’s recommendation was for the UCC to be retained at Lewisham, with provisions for the elderly and the development of a service for admitting some patients.

What Jeremy Hunt is proposing, however he chooses to dress it up, appears to be just that.