I have no idea what the rights and wrongs of this are … but if it is right to keep open the Whittington (and if what Dobson says is right, perhaps it is), does it mean they’ve built excess capacity at UCL and elsewhere?

What i mean is, if somebody somewhere in NHS planning has planned capacity in some places and not others, if those plans are reversed through campaigning, what does that mean for the investment that has taken place already to cope with A&E patients redirected from the Whittington? Or, do you think that investment hasn’t taken place, and rather than plan to re-organize services more efficiently while maintaining overall capacity, NHS planners have just decided to reduce capacity?

Oh, it’s the old chestnut of bean counters far, far away from the coal face being handed the authority to decide what essential services should be cut.

I can assure you that these people will be nowhere in sight when the chickens come home to roost – either they will be safely tucked up in bed, because a dire capacity issue has arisen at 2 o’clock in the morning, or they will have moved to an exciting new management position elsewhere in the DoH.

Since the 4hr target was introduced (in 2003) A&E has become something of a pressure cooker – don’t forget, nationally, 19 million patients visit each year, so the 98% of them who must be admitted or discharged within a narrow time frame present a major challenge to an already stretched part of the NHS.

For a more commonsense view ask any ANY of the neighbouring A&Es if they have either the capacity (or bed base within the hospital) to absorb 85,000 additional A&E patients who presently pitch up at the Whittington each year?

I can tell you the answer will be a resounding NO – the closure of this incredibly busy service will quite literally cost lives.

Isn’t the closure of smaller A&E units and their amalgamation into larger centers of excellence a good thing?

Patients deserve the best standard of treatment in a real emergency – and this is from 24 hour consultant-led care which amalgamates all of the advanced medical, surgical and diagnostic services in one site.

And for those patients that don’t really need this emergency care it doesn’t seem unreasonable to direct them towards GP and nurse led clinics where they could probably be seen quicker.

[3] “And for those patients that don’t really need this emergency care it doesn’t seem unreasonable to direct them towards GP and nurse led clinics where they could probably be seen quicker”.

Who gets to decide what is or isn’t an emergency – and who gets to carry the can for making such decisions?
Any experienced A&E clinician will tell you about cases that have gone very badly after vague symptoms presented diagnostic difficulties – cases that spring to mind include prodromal meningitis, potassium derrangement, and silent MI.

London ALREADY has its x4 regional trauma centres at The Royal London Hospital, Whitechapel, King’s College Hospital, Denmark Hill, St George’s Hospital, Tooting & St Mary’s Hospital, Paddington – not to mention dedicated 24/7 heart and stoke services providing primary angioplasty and thrombolysis at other sites.

The closure of the Whittington has nothing to do with improving services – its a cost cutting exercise, pure and simple.

Tony,

Your argument only works if there is any evidence that larger centres meet two criteria:

1. Provide a better standard of service, as larger does not always mean better (more staff can mean less personal attention for example).

2. That any benefits accrued from size compensate for increased risk due to greater average distance to an A&E.

As someone who has attended an A&E more than I would like in recent years, I can’t see how replacing it with GPs and nurses without the necessary facilities would help myself. Yes, there are people who attend A&E unnecessarily, but they are not the issue here – it is those that need the services that are important.

Tony – a larger centre of excellence is rather useless to a patient suffering a cardiac arrest if by the time they get there they’re already dead. A&Es need to be local to ensure effective coverage for emergencies where time to hospital is a factor.

Just as a general thought, can anyone deny this closure is the result of central planning rather than local considerations?

The obvious question is why should such decisions be made centrally, rather than by those who actually use the hospitals anyway? If it was indeed better in terms of care to have less centres, could not the case be made. Or are voters considered to stupid to make rational choices?

#7

I would say the dichotomy is accountable vs unaccountable rather than local vs central. After all there were MPs at this demonstration. So presumably in this case it wouldn’t matter if the decision was made at a more centralised level if it was made by members elected by the public, rather than decentralised but made by unaccountable people who’ve been appointed or elected by a very small number of people.

missed out a clause, meant to say “MPs at this demonstration from all wings of the Labour Party, from Jeremy Corbyn to David Lammy.”

[7] the original architect is NuLab’s ex-sockpuppet, Lord Darzi.

Darzi’s ‘vision’ was to downgrade A&Es and set up ‘polyclinics’ as an alternative to both A&E, and perhaps more importantly, GP services.
http://news.bbc.co.uk/1/hi/england/london/7607194.stm

Polyclinic were sold on the pretext of ‘convenience’ but this model has invariably been associated with NuLab’s privatisation by stealth agenda – very few people on the ground have a good word to say about them.
http://centurean2.wordpress.com/2010/02/02/nhs-safe-in-their-soviet-hands_ae-dept-close_-ussr-polyclinics-replace-them-8am-to-8pm-dont-have-an-accident-at-9pm/

It has been said that once established Polyclinics would soon be put out to tender, thus increasing the markets growing grip on health provision in the UK.

Funny how you don’t mention any of the many non-Labour groups present.

Especially given that this NHS run down is taking place after almost 14 years of Labour government. :<

Another failure of arrogant, bureaucratic, central planning.

Agree about the failure of central planning.

Not only is the planning process flawed it’s also not clear how local people will be consulted on these plans and if the consultation will mean anything at all or if NHS bosses will just push ahead with closures regardless of the outcome of consultations.

You can put your questions directly to those responsible for these plans at a public meeting in Hornsey on Thursday (4 March) at 8 pm:

http://whittingtonmum.wordpress.com/2010/03/01/public-meeting-with-nhs-bosses-this-thursday/

What have fucking cunts like Dan Hannan and the “libertarians” got to say about this? Is this hospital a 60 year mistake too?

According to their ideology, shouldn’t people be rejoicing at having been set free from the slavery of having health care?

I notice none of them have dared show their faces. Perhaps Worstall will be along to talk bollocks soon.

I live in Haringey – used to live in Islington. The closure of the Whittington A&E would mean that there will be no A&E facility in either of these boroughs to serve over 600,000 residents. We might as well be back in the dark ages. NuLab no doubt plans to recruit an army of new SPADS and Spin dictors to persuade us not to have accidents or get ill in future. What happens if there’s a major incident or terror strike? It’ll look like Haiti here in North London.

The Whittington treats 80,000 casualties a year. The NHS boss whose crazed scheme this closure option is has reportedly stated that the savings from closure cannot be quantified. She did not explain why. Of course the “savings” can’t be quantified because all the sick and ill and injured people will simply need to travel further to be treated. When they arrive at the distant hospital, they will wait for longer. There won’t be any real savings – especially after the new Polyclinics have been set up. That is, unless the whole Hospital is shut down and the site converted into flats.

Astonishingly, the same closure prospect is in the offing for many other essential A&E London Hospital services. This is a sytemic problem and the wrong people have control and very warped thinking has taken hold. The idea that making it harder for people to get emergency help will keep a lid on the future costs is laughable. People will die waiting and in transit. The same DoH/NHS simultaneously says it plans to move service “closer” to the user…

Politically, the Orwellian aspect is heightened by the sight of Labour party MPs from Haringey and Islington all now pledging to “Defend the Whittington/NHS”. Who are they defending it from? Their own party. Who created the new NHS corporate monster that is planning to rip itself apart in the interests of improvement (and with no sensible understanding of costs and benefits?)

Here’s a quick sum. If the Whittington A&E costs £40 million a year to run, then the 80,000 cases it sees are each costing £500. That doesn’t seem like a very high a price to mend a broken leg or stop a cardiac arrest or heart attack or pull someone through a car crash. A&E is a priority service. Not something we should be penalised for needing or discouraged from using. And the real truth is that the A&E doesn’t cost anything like that much once the hospital has been built (and this hospital has been there more than 100 years).

Besides, what the hell are we paying our taxes for if not for decent A&Es? I have paid around £25,000 in cumulative income tax since my life was saved at the Whittington A&E in 2006. That looks like an ok payback to me. When you’re dying, the last thing you need is a referral centre. You need a skilled A&E charge nurses and doctors who have the basic training and basic tools to pull you through. It might have been clinically uber hip best practice to get an instant angioplasty to clear a blocked artery at some super duper theatre in central London. Trouble is, you could so easily die waiting to get thre or while the Polyclinician is wondering if you’re not really very ill after all.

Hands off London’s A&Es! We need people in charge of the NHS who are accoountable to the public. Something has gone very badly wrong with the system.

Why no reference to the Liberal Democrat MP Lynne Featherstone attending this event? Why no reference to the leader of Islington Council as being the Liberal Democrat Leader of Islington Council?

This event was supported by all political parties, about the potential policies of this Labour Government.

Why, then, have Emily Thornberry and David Lammy supported the government’s policies on this? The hypocrisy of these loyalist Labour lowlifes is hideous.

I was one of the thousands on the march on Saturday. It was a fantastic event. I should declare 2 interests. I’m the Lib Dem PPC in Islington South – and like so many Islington families, I’ve been helped by the Whittington. They treated a micro-tumour and quite possibly saved my life.

There are many arguments against closing the Whittington’s 24 hour A&E.
Islington is a 24 hour borough, with a growing population; the Whittington is easily accessible by public transport 24/7. The Royal Free, which is the nearest alternative, is not. If the A&E is downgraded, then there is a risk to other core services such as the maternity unit, and to linked training facilities.

It’s more important to save the A&E than to have a go at other parties. But there are three structural problems that are of the Labour Government’s making and we won’t solve the problems facing hospitals like Whittington if we ignore them.

1) The drive to polyclinics is being used as an excuse to undermine core hospital services. Even leaving aside the financial/governance issues, if polyclinics do replace some hospital services, that will be around minor elective surgery and outpatient checkups, not A&E or maternity. Ironically, at the southern end of Islington, the pioneering 1930s Finsbury Health Centre, one of the first ever polyclinics, is threatened with closure.

2) The PFI scheme has not served Whittington well. Whittington Hospital is facing a £158 million bill for refurbishment works worth only £32 million – paying five times over for new facilities. This burden of long-term debt is a key reason behind the proposals to close down accident and emergency facilities at the hospital. We face the real prospect of closing facilities, yet still paying for them all the way to 2036. Not very prudent.

3) It may be clear that we don’t want to lose our A&E but it’s far from clear who makes the decisions. The elaborate tiers of quangos and lack of local democratic control just add to the frustration of local people. There is no accountability for the NHS locally and no ability for local people to influence the decisions. The only democratically-elected people in the whole system are the DoH ministers, who have proved masterly at buckpassing when the issue is raised for debate in Westminster.

These structural issues are the responsibility of the Labour government. While I don’t doubt that the local MPs, Labour and LibDem, are all sincerely against closure, the fact remains that unless they can secure a change of government policy, Labour MPs look at best ineffective and at worst hypocritical.

Bridget Fox
LibDem PPC, Islington South & Finsbury

[18] “The PFI scheme has not served Whittington well. Whittington Hospital is facing a £158 million bill for refurbishment works worth only £32 million – paying five times over for new facilities. This burden of long-term debt is a key reason behind the proposals to close down accident and emergency facilities at the hospital. We face the real prospect of closing facilities, yet still paying for them all the way to 2036. Not very prudent”.

And;
“Labour MPs look at best ineffective and at worst hypocritical”.

For those responsible, this goes far beyond anodyne terms like ‘ineffective’ – it borders on the CRIMINAL, not least because this extravagant waste of precious resources is a pattern being replicated elsewhere in the NHS.

I see from the official blurb that Rachel Tyndall “has a passion for improving the health of local people”.
http://www.islington.nhs.uk/meet-the-board.htm

Well, if our Rach really wants to improve the health of local people, then perhaps the first thing she needs to do is start listening to them – but that would only make sense if the entire consultation was not just a SHAM, and who actually believes that, eh?

PFI is all about handing over sackloads public money into private hands for the sake of Gordon’s vanity. Hopefully soon people will start to realise what a con its been and the damage it has done.

While there are strong reasons to close some hospital departments and set up specialist units as centres of excellence, for example in pediatric cardiology, A&Es need to be close to their areas of need. Many accident or critical patients cannot travel, their conditions are time-critical.

The closure of a busy A&E is an accounting exercise to pay for PFI. Its what you get when our hospitals (country?) are run by accountants and lawyers for the benefit of rich multinationals.

Hi Bridget,

completely agree with your analysis – except the last parapgraph.

To call someone like Jeremy Corbyn “ineffective” or “hypocritical” makes my blood boil (and I am not affiliated with any political party – I just care deeply for A&E and maternity at the Whittington and for those MPs who actually stand up for their constituents!)

So do me a favour and cut out the cheap electioneering. If politicians like you use this “matter of life and death cause” for their own tedious party political advantage – it really damages our campaign.

If you must work on party political lines then help us publicise the meeting with NHS bosses tommorow and encourage people to come along with their questions, it is organised by your fellow Liberal Democrat Lynne Featherstone
http://whittingtonmum.wordpress.com/2010/03/01/public-meeting-with-nhs-bosses-this-thursday/

[21] as a life long Labourite I feel deeply embarrassed about NuLabs stewardship of the NHS – I certainly won’t be voting for them this time.

Corbyn may be a god constituency MP but he is not even a side show in the much wider picture of dire health planing and financial waste (which I’m sure you’ll appreciate goes far beyond the situation at the Whitt).
Have a look at some of Allyson Pollock’s stuff as a useful starting point;
http://www.guardian.co.uk/commentisfree/2009/sep/03/nhs-business-markets

Bridget Fox’s analysis doesn’t go far enough in calling for culpability amongst those responsible for such a monumental waste of time and money – in fact, BF shows great restraint given the self evident imperatives driving these changes nationally (i.e. NuLab’s infatuation with market solutions).

What infuriates me is that there are few if any consequences (amongst the higher echelon) following yet another series of catastrophic blunders – in short we allow these muppets to yield immense power without responsibility.

If I screw up at work I may have to account to my employer, the NMC and even the courts – yet when millions are wasted on yet another unproven health initiative there is little more than a shrug of the shoulders.
Perhaps we have such low expectations because we have almost become accustomed to those without the requisite skills taking control of humungus sums of money?

If Corbyn or Lammy could actually change any of these dysfunctional processes then maybe, just maybe, they might deserve a few crumbs of respect – otherwise they are simply jumping up and down long after the horse has bolted.

Whittington Mum

I’m not local and freely admit that I don’t know much about this, but feel compelled to challenge your criticism of Bridget Fox for “cheap electioneering”. Bridget’s post was pointing out that the problems at the Whittington stem directly from Labour government policy and that the MPs who support the campaign locally implicitly support this policy by continuing to vote with the Labour party in parliament.

While everyone knows that Jeremy Corbyn is an admirably independent MP who would generally put the interests of his constituents first, the other two concerned here – Emily Thornberry and David Lammy – are not so viscerally independent. Emily Thornberry is famously loyal to the government, having rebelled only a handful of times in the last 4 years. David Lammy is a government minister.

If these two really support the campaign against the closure of the Hospital, they could do so in a much more dramatic way than showing up at a local protest they know it would be political suicide to avoid. Lammy could resign from the government for a start.

I take it from the tone of your previous post that you are a concerned local resident who is not inclined to party politics – good for you. In that case, all I ask is that you challenge the local Labour MPs to put their money where their mouth is and start to show some real support for your campaign.

PS: Yes, I’m a Lib Dem too.

#18

Absolutely. While it’s true that this is all largely of Labour’s making (whether that be through The Dastardly Darzi or their buck-passing to apparently unaccountable local bodies) there’s no way that Jeremy Corbyn or other local Labour politicians can be maligned in this.

One of the great things about Saturday’s march, and most of the campaign to date, has been the co-operation between Labour & the Lib Dems. Unfortunately some of the Lib Dem blogs have chosen to score political points on the back of a campaign which the local community takes very seriously. This is inevitable but unseemly and does those responsible no favours.

The Liberal Democrat’s decision to hand their own petition in to 10 Downing Street last week weakened the potential impact of several, from different parties and pressure groups, being handed in together.

Please, let’s continue with the campaign to keep the Whittington’s A&E open and leave the political sniping for another day. Local Lib Dems, Labour and, to a lesser extent, Greens have all done brilliantly so far. Don’t spoil it.

Interesting that if I a local resident like me comments on someone scoring political points in this discussion I get the guys from the same party like JF attacking me telling me if I challenge a point a LibDem has made in this discussion I MUST go and challenge Labour outside this forum.

JF – I do not have to do anything you ask me to, because – unlike you – I am not trying to prove that one political party is more hypocritical than the other. The only thing I MUST do is to help the campaign to defend the Whittington hospital so I can keep myself, my family and my community safe when someone has a serious accident.

So I’m with Dave P all the way: “Let’s continue with the campaign to keep the Whittington’s A&E open” – it’s a huge task trying to win this campaign – but winning it we must. The consequences of loosing are too awful to contemplate…

How far is too far for an A&E?

Answer that question before clicking on this link.

http://www.nhs.uk/ServiceDirectories/Pages/ServiceResults.aspx?Place=tufnell%20park&Coords=1857,5297&ServiceType=AandE&JScript=1

Labour politicians and activists behaved disgracefully at the rally – actually booing Green and Liberal Democrat speakers who dared to criticise the Government.

How do Labour politicians hope to have any impact on saving the Whittington A&E if they refuse to acknowledge the real problem and refuse to address the campaign to the people who are actually in charge, and malign anyone who does?

If anything, the refusal of local Labour politicians like Lammy and Thornberry to accept reality is actively harming the campaign. Time for Corbyn to show some of that independent spirit, I think!

@Mallory #27

“Labour politicians and activists behaved disgracefully at the rally – actually booing Green and Liberal Democrat speakers who dared to criticise the Government.”

I wasn’t aware of that, being on leaflet distribution duties during most of the rally.

If that’s true it’s pathetic.

@22 the a&e charge nurse

“If I screw up at work I may have to account to my employer, the NMC and even the courts – yet when millions are wasted on yet another unproven health initiative there is little more than a shrug of the shoulders.”

Business people can do no wrong. Mistakes and waste must be down to feckless public employee types. They must be punished and business folks must be rewarded for exposing them. Then Evan Davis can interview them on Radio 4 and they can appear on Dragons Den so their delicate little egos can have public service handjob.

It bloody sickens me.

[29] in case you hadn’t noticed there is a huge financial mess at the Whittington, not to mention quite a few other NHS services.

NuLab calculated, correctly, that the general public couldn’t give a fig about finances or provider as long as services remained free at the point of delivery.
Now the chickens are finally coming home to roost (mega-bills, closures, etc).

We can’t ask Lord Darzi about it – he has gone back to his robots;
http://news.bbc.co.uk/1/hi/8150808.stm

While ex-health supremo, Patricia ‘this is the NHS’s best year ever’ Hewitt is coining it in at Cinven & Boots (both competitors to publicly provided health services)
http://news.bbc.co.uk/1/hi/health/4935358.stm
And;
http://bloodandtreasure.typepad.com/blood_treasure/2010/01/pat-in-boots.html

But what about one of Hewitt’s predecessor, Alan ‘I’m spending more time with my family’ Milburn – surely he hasn’t got his finger in the pie has he?
Well, according to Wiki – “Following his resignation as Secretary of State for Health, Alan Milburn took a post for £30,000 a year as an adviser to Bridgepoint Capital, a venture capital firm heavily involved in financing private health care firms moving into the NHS, including Alliance Medical, Match Group, Medica and Robina Care group.
http://en.wikipedia.org/wiki/Alan_Milburn

Honestly, you couldn’t make it up.

Here’s an example of a current job going with NHS Islington.

http://www.jobs.nhs.uk/cgi-bin/vacdetails.cgi?selection=912438127

The thinking seems to be that people can simply be trained to avoid illness-type behaviour. As if… Well, there may be some truth in it but I don’t see how it can be a reasonable set of objectives for the local NHS to prioritise spending public money on this sort of activity. Surely keeping the local A&E open is more important? Still, the money simply does seem to be there for non acute management programme roles and acres of newspeak.

The theme seems to be that if you get ill or have an accident, it’s your fault. So let’s shut the A&E down to encourage people to be more careful.

Not sure about “huge financial mess” at Whittington. By definition the NHS is a cost centre and nothing to apologise for there. It’s not the staff’s fault if the PFI was a bad value deal. Who thought PFI would really fix the NHS?

Not wishing to score any political points – but if the local Labour MPs are powerless to get the NHS A&Es in london back on a sensible footing then we will all inevitably conclude this government will have lost control over what matters most.

[31] In 2002 Trevor Campbell Davis, Chief Executive of the Whittington Hospital, is reported to have said: “This major investment (PFI partnership with Jarvis) will increase our treatment capacity and provide our staff and patients with up-to-the-minute facilities, maintained to a consistently high standard. We expect our partnership with Jarvis to strengthen our high quality NHS services”.
http://www.jarvis-uk.com/jarvisplc/media/releases/pr2002/2002-10-21/

No mention of A&E closures, though, or the knock on effect throughout the rest of the hospital once it is no longer able to provide 24/7 emergency care.

Less than a year later Trev decamped from the Whitt in order to take up an exciting new challenge as Chief Exec at the John Radcliffe hospital, in Oxford;
http://www.brookes.ac.uk/about/structure/court/profiles/trevor-campbell-davis

Once there a PFI initiative followed as sure as night follows day;
http://www.publicservice.co.uk/pdf/pfi/issue52/PJ52%20Holcroft%20ATL.pdf

Yet only recently this mover & shaker was on his travels again – why?
A trust spokesman (at JR) denied rumours Mr Campbell Davis had tendered his resignation after refusing to agree to the 370 redundancies announced in a £44m savings package.

A trust spokesman also claimed Mr Campbell Davis, who took up the role in 2003 and is paid between £185,000 to £190,000 a year, was on leave for “personal circumstances not appropriate to discuss publicly”.
http://www.thisisoxfordshire.co.uk/news/4512219.Hospital_staff_told_health_chief_is_off_to_new_job/

Let’s be clear. Whittington Hospital is far from being the only part of the NHS currently facing the prospect of cuts and closures:

“One in three accident and emergency (A&E) departments could close across London, the BBC has learned.”
http://news.bbc.co.uk/1/hi/england/london/8506565.stm

“Many NHS primary care trusts are in deep financial trouble. More than a third of trusts, which fund hospitals in England, are running deficits which have led to a cut back in surgerical operations and seen calls to close casualty departments – according to a joint study by the Guardian and think tank Civitas.”
http://www.guardian.co.uk/society/datablog/2010/mar/02/nhs-deficits-data-pct

“[Ministers] will encourage the NHS to make efficiency savings worth £10bn, partly by cutting expensive IT, but also by merging primary care trusts in big cities.
http://www.guardian.co.uk/uk/2010/mar/03/treasury-spending-cuts-budget

“What have fucking cunts like Dan Hannan and the “libertarians” got to say about this? Is this hospital a 60 year mistake too?

According to their ideology, shouldn’t people be rejoicing at having been set free from the slavery of having health care?

I notice none of them have dared show their faces. Perhaps Worstall will be along to talk bollocks soon.”

This hospital existed before the NHS. In fact, it was THREE hosptitals before the NHS ‘amalgamated’ them: http://en.wikipedia.org/wiki/Whittington_Hospital

So yeah, the NHS: 60 years of ‘rationalising’ services.

Just to report back from the public meeting with NHS bosses last night:

Rachel Tyndall and Richard Sumray failed to present convincing data or evidence for the A&E closure. I am shocked.

More on the meeting here:
http://whittingtonmum.wordpress.com/2010/03/04/high-profile-nhs-panel-struggles-to-present-case-for-ae-closure/

Difficult to maintain hefty PFI costs without cutbacks?
http://www.camdennewjournal.com/letters/2010/mar/let’s-have-end-secrecy-nhs-and-money

Perhaps a Virgin-owned Polyclinic can fill the void?
http://www.islingtongazette.co.uk/content/islington/gazette/news/story.aspx?brand=ISLGOnline&category=news&tBrand=northlondon24&tCategory=newsislg&itemid=WeED03%20Mar%202010%2013%3A39%3A10%3A727
And;
http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4125253&c=2

For ‘consultation’ read – how hard are local people prepared to fight NuLab’s covert privatisation of the NHS agenda?