A war of attrition against hospital services in South Tyneside and across the country
Will Boris Johnson’s promises of NHS cash mean anything? Or will children's and other hospital services continue to close down to save money on staff?
On 5th August 2019 children’s A&E services in South Tyneside Hospital will close between the hours of 10pm and 8am. Local health bodies have carried out an astonishing mass leafleting and advertising campaign to keep children away from the hospital. As a result thousands of very sick children from one of the poorest areas of the country will now need to travel across the river from South Tyneside to Sunderland. Instead of being able to access the Children's A&E within minutes in an emergency, they will be more than 30 minutes away by car or will need to take at least two buses to reach Sunderland Royal.
The hospital’s trust is also planning to downgrade full maternity services, closing the Special Care Baby Unit (SCBU) and leaving only a midwife led unit. It has already closed stroke services in advance of consultation.
This is an oft repeated pattern nationwide. When NHS England (NHSE) and Clinical Commissioning Groups (CCGs) and trust managers decide they want to close a hospital and associated services they do it by attrition, bit by bit, to slow down and overcome public opposition. The closure of a baby unit, the removal of A&E children’s services, the downgrading of a maternity services or the removal of acute orthopaedics spells the end of the A&E department and leads to the closure of many departments and with them the end of the district general hospital (DGH). This is because a DGH is not viable without core acute and emergency services.
As with other NHS hospital and service closures up and down the country, the decision is being strongly opposed by local people. For the last three years the Save South Tyneside Hospital Campaign (SSTHC) has been fighting to prevent their DGH from being downgraded. Similar campaigns are going on across the country.
Last year SSTHC took the CCG to judicial review on the grounds of the consultation being unlawful and of equality of access to services. They lost but signalled their intention to appeal. The judgment, however, was not handed down until 23rd July 2019. Regardless, the trust has proceeded apace with Phase 1 of their plans ‘Pathways to Excellence’, in reality Pathways to Closures, helped by the trust merger.
The plans particularly affect the 156, 000 people living in South Tyneside, which is among the most deprived local authorities in the country. One in three children (36.52%) in South Shields constituency live below the poverty line and for adults life expectancy is between eight and ten years less than the English average.
Phase 1 of these closure plans targets services for mothers to be, newborn babies, and children. Senior consultants in the trust report that the numbers of children attending A&E almost quadrupled from 6,000 in 2012 to 21,000 in 2018, but despite the huge increase in numbers, the service has consistently delivered the highest standards of care year on year. 3,600 children are seen in the Children's A&E between 8 pm and 8 am each year. The children’s service is in the top five in the country for shortest waiting times. It is a national example of how efficient services should run according to NHS constitutional waiting times dashboard reported by South Tyneside CCG.
But from 5th August between 10pm and 8am each day the shutters will come down on the children's A&E. If a child is brought in after 10 pm, they will go to the current adult A&E (which will become generic A&E at night) where they will be triaged and rapidly transferred to Sunderland. If a child is very sick, staff in the adult A&E (who are not experienced in sick children) will resuscitate the child and stabilise them, until their 'rapid transfer' to Sunderland. Paediatric consultants have been told they should not to respond to A&E staff requests for help for children admitted after 10 pm as the trust does not want it known that experienced paediatric staff may be available for assistance until midnight.
The plans to replace acute maternity care with a new midwife-led unit for "low risk" mums are equally dubious given that need is unpredictable – as an audit of special care baby unit (SCBU) babies last year showed, many babies who needed to be admitted to the unit had been deemed low risk prior to delivery.
When the University Hospital of Hartlepool replaced its full maternity services and SCBU with a midwife-led unit, it lead to the closure of its A&E and all its acute services. Numbers declined in last 10 years, with women choosing to go to North Tees since the full maternity closed and so this month on 20th July the Trust announced its closure.
The plans are driven by deficits not local needs.
In 2016 NHSE and the Sustainability & Transformation Partnership (STP) for Northumberland, Tyne & Wear and North Durham set out plans to cut its annual budget by £641 million by 2021 – the cost of running several hospitals every year. These plans can only be achieved by service closures, more land sales, and NHS sell offs.
Until April this year South Tyneside and Sunderland hospitals were two separate foundation trusts (FTs) each serving their own communities. Both hospitals had deficits due to underfunding of around £10m and £15m for South Tyneside and Sunderland Royal respectively in 2017-2018. Only a £13.5m plus bail out by the Sustainability and Transformation Fund and NHSE enabled Sunderland FT to remain solvent in 2018. It was, nevertheless, predicting a recurring deficit of in excess of £11m the following year (see here).
Foundation trusts are able to raise 49% of their income from private sources, and have power to dispose of land and assets. Effectively the only way in which deficits can be cured are for services to close and for the land and buildings to be sold off. Effectively the only way to close services is to merge hospitals and so, in April 2019, the two hospitals were merged under Sunderland FT to become one body. The multi million pound bail out from NHSE the previous year was to enable the hospital merger to take place in order to facilitate part closure of South Tyneside Hospital. Hospital mergers uncouple services from residents’ needs as the financial interests of the trust come before the needs of patients. Moreover there is no local accountability, as the Health and Social Care Act 2012 abolished locally accountable geographic planning bodies.
I visited the South Tyneside DGH on a sunny evening last month. Even at first glance it is clear that it is a well loved and well cared for hospital. The large multi hectare site has an up to date emergency A&E, an Urgent Care Centre, the Children's A&E, outpatients diagnostics, a maternity wing with birthing pool, and theatre suites, all upgraded within the last decade. The trust has a rich estate; it owns Palmer Community Hospital, Clarendon, and Primrose Hill Hospital in Jarrow,. These are valuable assets, which Sunderland Royal was keen to get its hand on, not least having sold off a great deal of its own land and buildings.
Thus far South Tyneside and Sunderland councils have been on the side of local people. They opposed Phase 1 of Pathways to Excellence and the joint scrutiny committee referred the decision to Secretary of State’s Independent Reconfiguration Panel, which ignored their concerns.
Since the merger, the CCG and FT have been negotiating with council leaders to implement Phase 2 of the plans which will include consolidation of services and possible new builds, and which it is feared will mean loss of all acute services in South Tyneside. The new medical school in Sunderland is predicated upon major expansion and investment including at Sunderland Royal. Apart from land sales there will be little public capital available. It’s a bitter pill when cash-strapped local authorities in the poorest areas are being asked to borrow and provide finance for new hospital services. The trust is on record as having asked South Tyneside Council for £35m and Sunderland for £15m.
Everyone is worried. Local MPs have raised their concerns in Parliament. Staff have raised their serious concerns in meetings and in writing. The trust is concerned about a child presenting to A&E at night in the absence of experienced staff. A&E staff providing adult services have raised concerns in writing during the service review.
And what of the medical schools? South Tyneside DGH lies between two medical schools. Sunderland to the south has a brand new medical school. It ought to be a no brainer to keep this important hospital open, especially in an area with high health needs and great deprivation. Newcastle University to the north is just 10 miles away from South Tyneside hospital. It has a large and expanding medical school. It too needs services and hospitals for students for patients and to train doctors. If services close, where will patients go and where will students, doctors, and nurses train?
The consultation for Phase 2 of Pathways to Closure, aka ‘The Path to Excellence’, has been launched, but the battle to stop phase 1 is not over. Local authorities and CCGs must insist the trust be accountable and until the appeal is heard stop their plans to close necessary and life saving services children’s and maternity services on 5th August. It remains to be seen whether the new monies promised for the NHS will help to offset the deficits and prevent service closures.
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