Kaya Makarau-Schwartz, a volunteer for the save the Whittington campaign, writes a background guide to the proposals on the Whittington.

The Whittington Hospital serves 250,000 in the boroughs of Islington and Haringey from parts of Barnet and Camden. It has benefited from large amounts of investment over the few years these include, £30 million on a new wing including an Intensive Care unit. Also, the refurbishment of the maternity unit which includes a new birth centre, a neonatal intensive care unit that was expanded through an investment of £600,000 and a new £500,000 paediatric A&E unit was opened in 2008.

The Hospital employs 2000 members of staff and has a 400 bed capacity. In 2009 they treated 20,000 inpatients 16,000 day cases and saw 233,000 outpatients. The maternity delivered 3683 babies and the Accident and Emergency department treated 80,000 people. The Whittington also has very high levels of bed occupancy. The Hospital is sited in a densely populated area and is near major transport intersections.

The North Central London services and organisational review (covering Barnet, Camden, Haringey and Islington) has been looking at the implications of the Framework for action – Healthcare of London report. This has included services under the remit of Islington PCT including the Wittington Hospital. The report published by the review looked at the Clinical Advisory groups consideration of models set out in the framework and concluded that in the North Central London region there should only be three Major Acute Hospitals two of which are proposed to be in Camden and two local hospitals.

The review did not consider the Whittington in the short list as a major acute hospital which would have major implications on the existing services at the Wittington and the populations they serve.

Where a proposed major acute hospital includes the services currently provided at the Whittington, the proposed local hospital models would all lead to a down grading of services at the Whittington and could easily lead to other departments in the Whittington closing, potentially resulting in the end of the whole hospital. Even the medical, surgical and emergency hospital option which does have 24 hour A&E has maternity services as only a possibility.  

The proposals put forward have major implications on acute care for the residents of Haringey and Islington and parts of Camden and Barnet as well as services at UCH and North Middlesex who will be unable to cope with extra demands on their services. A full consultation on the options should have taken place and the evidence for the proposals made public.

The following is a summation of issues that have been raised so far within the context of public meetings and correspondence received by Jeremy Corbyn MP. 

Opposition so far,

There have been Early Day Motions, parliamentary debates, local council motions, public meetings, press coverage, residents’ campaigns, staff campaigns as well as campaigns by local political parties. It is clear that outside of the North Central London NHS committee there is no support for the proposal.

Population growth

There is a clear indication the population will rise by 2020. In Islington the increase could be as much as nineteen percent which is the largest predicted rise in the North Central area and the fifth highest across London.

Maternity

There is a predicted rise in the number of births in London which will increase the work load of obstetric and midwifery services which are already 3700 births a year at the Whittington which is higher than both the UCL and the Royal Free. The Whittington Hospital’s maternity unit has been refurbished in the last year leading to better facilities, as has the neonatal intensive care unit funded by public appeal; this shows the need and local support for theses services. All natal services rely on the accident and emergency department to support emergency admissions and any other unforeseen eventualities.

Deprivation / health needs and inequalities/ life expectancy

The Framework for Action document cites one of the reasons for change as “one city but big inequalities in health and health care”; an example given is the infant mortality rate in Haringey: 8.1per thousand births which is three times that of Richmond which is 2.7per thousand births. Most of Haringey’s residents are reliant on the Whittington for A&E and Maternity services as the closest of these services will surely increase this indicator of inequality when the strategy points to wanting to decrease inequalities. Further evidence can be found in the North Central London Health Service Configuration, document which states that the two most deprived areas out of the five North Central boroughs are Islington and Haringey which are densely populated and have the fourth and fifth highest levels of deprivation in London. High levels of deprivation can be directly linked to high levels of poor physical and mental health. However, the proposal is to leave both these areas without access to locally based Accident and Emergency and Specialist services, surely this goes against one of the main tenants of the strategy.

To further compound this point the North Central London Health Service Configuration, document also states that Islington has the lowest life expectancy rate within North Central London and that people who die prematurely are more likely to live in the most deprived areas, therefore locally accessible high quality services such as those at the Whittington should be developed rather than curtailed.

Ethnicity

According to The Framework for Action document, “healthcare needs to be accessible and acceptable (e.g. culturally appropriate) to all”. The North Central sector is both culturally and ethnically diverse; in Haringey the 2001 census suggested that at least 55% of the population are from Black and minority ethnic communities. This is important in relation to health because of the high number of people from black and Mediterranean backgrounds that can be affected by Sickle cell and Thalassaemia. The Whittington Hospital treats the largest number of people with these conditions in the country. Access to Accident and Emergency is essential for people with these conditions as those who go into crisis need urgent and appropriate attention.

Opening Hours

It seems very strange to propose to have an Accident and Emergency service that runs any less than 24 hours a day seven days a week in an inner London borough. Any argument for lessening this time would have to be backed by strong evidence that the vast population of Islington, Haringey, Enfield as well as Barnet and Camden only become sick or injured in “waking hours” which seems highly unlikely. The Whittington has already accommodated the needs of children in their new children’s Accident and Emergency area in order in part to make children and their parents feel safe when coming in to the hospital late at night.   

Consultation

There have been serious concerns about how potential Whittington users who are an estimated 1.3 million will be consulted on the proposals for the future Whittington Hospital. The Minister of state Mike O’Brien was clearly confused as to why there was consultation even happening when the have been no clear proposals yet. The Early Engagement Deliberative event on 21^st November 2009 was only attended by eighty people with only three out of the five Links’ chairs, and no one representing Whittington staff. The outcome of the event being very unclear, a request for a copy of the results of this deliberative event should be made public. Our public meeting on the 9^th of December had an estimated three hundred and fifty people, including local residents from many of the north central boroughs as well as people representing the staff of the primary care sector and the voluntary sector.

Furthermore one of your major points in the case for making changes is financial pressure and yet you commissioned a consultancy firm to arrange and hold the Early Engagement Deliberative event, the cost of which should released to the public.

Therefore future consultation must be wide ranging and cost effective.  

The Proposal for closing the Accident and Emergency at the Whittington is part of a wider scheme to have a more developed primary care system that may in the long run lead to a lesser need for Accident and Emergency services. However it seems absurd to start this scheme by cutting what are presently very well used services, surely the whole scheme should be put in place and then evidence of the scheme working should be presented as a case to close an accident and emergency service.  

Accessibility and emergency journey times

Serious consideration needs to be given to how patients in an emergency situation would access treatment if the Whittington’s Accident and Emergency was closed. The Royal Free which would be the next closest hospital to the Whittington has not got a tube station and it only has one bus directly from the North Islington area; the C11 which is known for its unreliable service and is a single decked bus. There surely would need to be talks with Transport for London on making the Royal Free accessible none of this is mentioned in any of the proposal documents. The Whittington is already accessible by many buses and has the Archway station in close proximity. The key point of having Accident and Emergency services is to provide care in situations that require immediate attention situations where every minute is vital to keeping people alive. How can you say you are providing reasonable and safe care of those in the North Central area when you will prolong the times for which someone from Islington, Haringey and Enfield receives emergency hospital treatment? 

Unforeseen Circumstances

It is unclear from the policy documents what will happen in the case of a major emergency. London as the capital city is the most likely target of terrorist attacks. If another July 7^th occurred how will casualties be helped by a lessening of services? Similarly with the more extreme weather patterns we are experiencing in the UK how will not having access to local emergency services help if roads are blocked because of such weather. In Islington the Arsenal stadium is capable of seating 60,400 people, if there was any kind of critical emergency how would that be dealt with without the Whittington’s Accident and Emergency.  

Intensive care

In the Approach to Development and Assessment of Possible Option document the reason for the Whittington not being considered becoming a Major Acute Hospital is given as the small number of in-patient beds and more Intensive Care Unit beds. Even though in the North Central London Health Service Configuration document listed as an additional driver for change is the reduction of dependency on in-patient care.  The Whittington has very high rates of bed occupancy which was sited as an issue that needs to be addressed in the North Central London Health Service Configuration document.

Furthermore, the recent 30 million investments into the Whittington partly was spent on the Intensive care unit, which shows a willingness to improve the ITCU. In most of the proposal documents it states that the estate of a hospital should be taken in to consideration seeing as much of the Archway campus is becoming available. Partly due to the Archway Sexual Health Clinic moving to supposedly amalgamate with the Northern Health Contraceptive Service, although it has recently been realised that a full amalgamation would not be possible due to how the two services are paid for, which shows how difficult it is to organise the amalgamation of services. Surely there is an argument for extending the hospital services back over into the Archway Campus.      

The NHS Choice “Your health, your choices” website shows in the “What patients say about this trust area” the Whittington gets far better reviews than the Royal Free including a question on the A&E services. http://www.nhs.uk/

Background, Kaya Macarau-Schwartz, Whittington