Questions of cost and capacity hang over the planned reconfigurations of hospitals in Leicester, where a consultation with limited scope for public involvement concluded on December 21.
There are four main grounds for concern – the limited capacity of the new hospital and lack of any pandemic awareness or preparedness in the plan; the centralisation of almost all of Leicester’s maternity services in a massive new “baby factory” maternity hospital in Leicester Royal Infirmary, handling 11,000 births a year and the closure of the free-standing midwife-led unit at St Mary’s; and growing questions over the affordability of the project within the allocated sum of £450m.
The financial concern is underlined by the fourth problem: the hopes that the acute hospital plans could be viable without any increase in capacity hinge on the expansion of community-based services – for which there are no detailed plans – and no funding available.
The Consultation document states clearly that: “This consultation does NOT include community hospitals, GP practices, mental health and other services provided in the community or in people’s homes.”
Separating the hospital plan from community health services effectively means discussing only half the plan, with the other half reliant on wishful thinking.
The underlying plan as set out in the 600-page PreConsultation Business Case (PCBC) (with over 200 pages of appendices), was drafted in obsessive secrecy, finalised in 2019, and eventually signed off in January 2020 – just before the Covid pandemic struck in full force. All of the “public engagement” it refers to was years ago, in a different time completely.
But as we reported in The Lowdown rather than pause the already delayed process to allow a proper evaluation of the longer-term implications of the pandemic for the design and capacity of hospital services, the decision was taken last September to rush ahead with a 12-week consultation on a £450m scheme that will irreversibly change local hospital services by selling off land and buildings. Only a flimsy retrospective 4-page preface to the PCBC makes even passing reference to Covid-19.
Critics warn that the plan is far from Covid-proof, especially since it involves extensive sales of land and buildings on the Leicester General site, and they have pointed out that the PCB promises and speeches promising additional acute beds are not borne out by the actual plans put forward in the consultation document.
The PCBC states (page 11): “A bed model has been produced to support the reconfiguration plans and the proposal is to increase the current level of beds from 2,033 to 2,333. Therefore there are no proposals to decrease bed numbers.”
However a closer look at the actual proposals reveals that the 300 additional beds are largely imaginary: indeed there is NO plan to build any additional beds at all. The Consultation document states a completely different target total of 2172 beds: “UHL has calculated that there would be a need for another 139 acute beds by 2023-24. This would be an increase of 7% on the current total of 2,033 beds.”
In fact none of the official figures reported in recent NHS statistics show anything like 2,033 beds available in Leicester.
The most recent Bed Availability and Occupancy figures (July-September 2020) show the Trust had a total of 1,668 beds open overnight, 1,554 of which were front-line “general and acute” (G&A) beds, of which 1,202 (77.8%) were occupied. In addition, there were 116 ‘day only’ beds, 60% of which were occupied. This gives a maximum total of 1,784 beds.
The most recent figures available on winter pressures show UHL had even fewer G&A beds available in January, with just 1,492 beds, 1,270 of which (85%) were occupied; while the weekly Covid admissions reports to January 19 show an even lower total of 1,448 G&A beds, 91% of which were occupied, 412 of them (28%) Covid patients – with another 60 Covid patients in ICU beds.
The actual figures at no point connect with the picture drawn in the Consultation Document – but are consistent with the high levels of pressure on NHS services generated by the Covid pandemic. None of this gives any confidence that the planning is coherent or robust in the new reality for the NHS.
Meanwhile the focus of campaigners has shifted to the worrying proposals to create Europe’s largest single unit maternity hospital at Leicester Royal Infirmary, handling 11,000 births a year, far higher than the 8,000 in England’s largest single unit, in Liverpool, and the 10,000 per year in Dublin’s National Maternity Hospital.
The new unit would result in the closure of services at Leicester General as well as the loss of the free standing midwife led unit at St Mary’s in Melton Mowbray – a double blow for women in the immediate area, East Leicestershire and Rutland, who would lose the local choice of St Mary’s and the easier access to Leicester General, and face much more onerous and lengthy congested journeys to the Royal.
There are doubts over the future of free-standing midwife led births in Leicestershire, since the plan only commits to a 12-month trial of a unit to be located on the Leicester General site: it has been set a target of at least 500 births a year to secure ongoing funding. Critics point out this is almost certain to fail, since it will not offer the postnatal beds and additional support available at St Mary’s, and because the limited trial period means that from four months onwards women will be less likely to choose to give birth in a unit that might be closed when they need it.
An excellent detailed critique of the plan by De Montfort University’s Dr Sally Ruane and Kathy Reynolds also points out that the plan appears to diverge from the insistence on choice in national policy guidance, the risks of concentrating all births in one building (and distances to any alternative services) and warns that the new model of care would increase levels of medicalisation and intervention, and prove less satisfying work for midwives, raising the question of recruitment and staff shortages as well as patient care.
The Royal College of Midwives head of policy Sean O’Sullivan told The Lowdown that the plan has not sought the views of the RCM, and that his immediate reaction to a single unit that large was a “degree of scepticism” over the practicalities of staffing. “A unit that large would need to be running two rotas of medical staff in addition to consultant cover.” The other obvious question was whether it was wise to press ahead with such a plan in the midst of a pandemic in which energies and attention were largely focused elsewhere.
Add to this the strong likelihood that the eventual cost of the Leicester project will far outstrip the £450m allocated – as has happened with new hospital projects in Shrewsbury (where the capital cost was estimated at £312m, but swiftly rose to £498m in a report leaked in December 2019, and was most recently said by STP Chair Sir Neil McKay to be £533m) and South West London (where the Epsom & St Helier Hospital Trust board meeting in January heard that the timeline for the Outline Business Case phase of the Building Your Future Hospital programme is now seen as “very ambitious” and that there have been significant changes in what needs to be incorporated within the programme “including COVID design implications” which make the project much more expensive, with the risk that the final design becomes “unaffordable”).
Wise managers would heed the warnings from campaigners, experts and academics, pause the project until the pandemic is clearly under control and revisit the scheme, the capacity required in hospital care, the scale of associated community health developments that are required, and the combined actual costs – and check its viability in the post-Covid “new normal,” and whether adequate funding will be available.
Sadly nobody expects Leicester bosses to follow that course, unless campaigners can persuade local politicians of all parties start to take the problems seriously and pile pressure on the Trust and the three local CCGs to do the sensible thing before serious damage is done.
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