News / South London future decided as Hunt opts for compromise

Health secretary Jeremy Hunt has accepted the majority of the trust special administrator’s (TSA) recommendations on the future of healthcare in south London, though he opted to compromise on the controversial proposal to close the A&E department at Lewisham Hospital.

The TSA had made a number of recommendations, most of which appear to have been accepted by the health secretary. These included the proposal to dissolve South London Healthcare NHS Trust, which was losing about £1m a week and had accumulated debt of more than £200m. By October each of its three hospitals will be taken over by neighbouring trusts, subject to regulators’ approval.

Mr Hunt also said the three hospitals would have to find almost £75m in efficiencies identified by the TSA. The Department of Health would pay the excess cost of private finance initiative buildings. It would also write off the trust’s accumulated debt.

The minister called in NHS Commissioning Board medical director Sir Bruce Keogh to advise on the proposal to close Lewisham’s A&E department. Although the unit is not part of South London Healthcare , the TSA said the action was needed to ensure the financial sustainability of the local health economy.

While understanding the financial reasoning behind the proposal, Mr Hunt decided Lewisham should have an A&E for less serious conditions – treating up to 75% of patients who currently attend. Very specialist emergency care will be centralised at four sites in south-east London.

‘What is in the clinical interests of patients in south-east 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,’ he said.

‘However, some changes need to be made so that money is spent on patient care rather than servicing historic debt. The decisions I have taken today will ensure that patients in south-east London will be able to rely on the NHS for years to come.’

The Lewisham trust’s maternity unit will be downgraded and the Department said an extra £36m has been earmarked to ensure there is sufficient maternity capacity at the other sites. An additional £37m will further expand services at the specialist hospitals for more serious conditions.

Lewisham Healthcare NHS Trust was disappointed with the decision to downgrade its A&E and maternity services. ’Clearly, we need more information before commenting in detail. The trust board response to the consultation was clear that we believe Lewisham needs full emergency and obstetric services,’ a spokesperson said.

NHS Confederation chief executive Mike Farrar admitted that changes to local health services would always create strong feelings and concern. Quality, supported by clinical evidence, must always be the driving force behind change.

He added: ‘We need to learn the lessons from this case and others. The answer is to start discussions earlier, with doctors and leaders clearly explaining the case for change. Otherwise we will find ourselves perpetually in a situation of trench warfare, with staff, politicians and patients all coming out in opposition on the streets.’