Hospitals trust may split, chief executive admits

EPSOM General Hospital could be split from its St Helier sister site in Carshalton as the NHS trust that runs them looks unlikely to be granted foundation status as it stands.

The news?has led to fears resurfacing about the future of the hospital, amid?a suggestion that it could end up as "some minor facility tagged on to some other trust that is miles away".

Last week, staff at Epsom and St Helier University Hospitals NHS Trust were told?that the organisation?would struggle to move forward in its current form.

A board meeting was held on Friday (December 10), when alternatives to?foundation trust status - a requirement for all hospitals to achieve by 2014 - were considered.

These?included separating the two hospitals, some of the services being provided elsewhere and possibly Epsom being absorbed into a different NHS?trust.

Councillor Sandy Sanger, chairman of the social committee at Epsom and Ewell Borough Council, said: “We have seen a lot of hard work put in to develop the strategic outline case which should have resulted in significant capital investment in the Epsom Hospital site in the near future.

“Once again people’s expectations have been raised, only to be dashed some time later.

“I know that this move will cause a lot of anger and disappointment.

“We will be closely monitoring the services at our hospital and we will fight any proposal to shift them to St Helier prior to any formal changes.”

It is thought a campus option, which proposes a mix of activities on the site, may best guarantee the hospital’s future.

The borough council lists championing local health service improvements as one of its key priorities, and Cllr Sanger said other options being discussed by the trust would be very unpopular with people in the area.

“Residents do not want Epsom Hospital to end up as a minor facility that is tagged on to some other trust that is miles away.”

Samantha Jones, chief executive of the Epsom and St Helier trust, said: "I am conscious that this news will be disappointing and I can’t stress enough that the decision is based in no way on our performance over the last few years and all the work to improve the care we provide to patients.

“We now need to create a credible plan for our hospitals to achieve foundation trust status, whether on their own or in partnership with other organisations.

“People will of course ask how this decision will impact on our plans to spend millions of pounds redeveloping both Epsom and St Helier hospitals.

“As such, I would like to reassure them that, whatever the final outcome, we are still fully committed to both schemes and, as you will know, they have received significant and continued support both inside and outside the trust.”

The trust has also been criticised by?the public services?union,?Unison, over plans for nurses to drop a day’s annual leave to help?ease financial problems. Mrs Jones made the plea in an e-mail to staff because of a ￡30m black hole.

She said some doctors had agreed a wage cut and that she would give up one day of her annual leave.

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Community hospitals' review and IVF stopped

COMMUNITY hospitals in Surrey are under the microscope as the county's primary care trust tries to tackle its ￡125m budget deficit.

IVF treatment for new patients will also be stopped, while planned care for smokers will be deferred until they have completed a course to help them kick the habit.

The plans were announced at?a meeting of the?NHS Surrey?board?in Cobham on Friday, which?also heard about proposals to create an enhanced community hospital hub system but at the expense of some sites.

Early indications are that the expanded services will be offered at hospitals in Woking, Farnham, Haslemere and Caterham Dene.

However, with no money to invest in these services, board members admitted that some community hospitals in other areas of Surrey would have to be sold off.

Cliff Bush, chairman of the Surrey Local Involvement Network, said at the meeting: “We have to understand that we will lose the other community hospitals as we need to make sure that we get the best services and transport provision for patients. I’m being realistic.

“The whole process will be consulted on. No decision has been made yet, but we have to understand that there’s financial consequences here.”

Cosmetic treatments

According to NHS Surrey, the current number of community hospitals in Surrey means vital services are stretched thin, and the?future may mean expanded?operations but across fewer locations.

The aim is for the enhanced community hospitals?to provide 24/7 consultant-led inpatient care, and they would also be able to receive ambulances.

The board approved a list of procedures and treatments that will be streamed into a 'Fast, Steady, Stop' programme, depending on their nature and how serious a patient's condition was.

Cosmetic treatments like female facial hair and tattoo removals are in the ‘Stop’ stream and will no longer be funded by NHS Surrey.

Other services to see funding withdrawn include acupuncture, treatment for male baldness and spinal epidural injections for chronic back pain, apart from in exceptional circumstances.

Treatments labelled ‘Steady’ include routine hip surgery, where NHS Surrey said it intended to honour the 18-week waiting time, while all life-threatening cases would be undertaken as normal.

"Cost pressures"

Dr John Omany, medical director at NHS Surrey, said: “Over the past months we have seen a substantial rise in referrals for non-urgent or low priority procedures.

“In addition, there is increasing evidence that for some procedures, significant numbers of patients report no clinical benefit.

“By stopping doing things which aren’t clinically necessary, we can safeguard and continue to do what’s clinically essential or urgent, such as cancer referrals and life-threatening trauma cases in A&E.

“Going forward it is clear that the NHS cannot continue to offer treatments where there is no or very limited clinical evidence or which are predominantly cosmetic.”

Current courses of IVF will continue, but starting from next month any new referrals will not be funded.

Women who are nearing the age?of 39 might still be considered in certain circumstances?though, and the IVF policy will be reviewed next November.

Anne Walker,?chief executive of NHS Surrey, said they started 2010/11 needing to make savings of more than ￡125m.

“Whilst we have made steady progress and delivered significant savings through a range of schemes, additional cost pressures have been incurred during the year.

“As a result, our latest forecast is that unless urgent action is taken we will end the year with a deficit of over ￡35m, which is clearly unacceptable.”

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Maternal deaths report slams conditions at Skeldon, N/A Hospitals

By Michael Jordan
Although she was a high-risk maternal patient, no ultrasound was ordered for acting headmistress Esther Dwarka-Bowlin, no blood was available for her when she needed a transfusion, and no doctor was present when she was ready to deliver.
These are some of the findings that have emerged in a preliminary report into the October 16 death of 29-year-old Dwarka-Bowlin, and the recent deaths of three other maternal patents from the Skeldon and New Amsterdam Hospitals.
A complete review of the four cases is to be done by the Expert Maternal Mortality Committee set up last week.
This report would be followed by a comprehensive report fashioned by an ongoing investigation.

Nadira Sammy

Rebekah Chinamootoo

The preliminary reviews were done by the Ministry of Health into Dwarka-Bowlin’s death, as well as those of Nadira Sammy, a 15-year-old from Number 69 Village, Corentyne, who died on September 16; Rebekah Seegobin (also called Rebekha Chinamootoo), 27, of Number 36 Village, Corentyne, who also died in September; and Heerawattie Bisham, 21, (also called Yogeeta Bisham), who died on October 20.
The report raises several questions about the quality of treatment that the women received.
Among the observations made was that high-risk patients were left in the hands of junior doctors, who were unable to handle emergency maternal cases.
A similar observation was made during the Guyana Medical Council investigation earlier this year into the deaths of high-risk maternal patients Tricia Winth and Salima Ram at the Linden Hospital and the West Demerara Regional Hospital. No staffers were disciplined, although investigations revealed that negligence contributed to their demise.
The report on Esther Dwarka-Bowlin states that hers was a post-term pregnancy (a pregnancy lasting 42 weeks or more). She was referred to the High Risk clinic at 36 weeks and again at 41 weeks.
According to the report, Bowlin was admitted to the Skeldon Hospital 44 weeks into her pregnancy on October 15,? at 19:45 hrs. It said that her blood pressure increased on two occasions, and she was given Aldomet (a medication for hypertension) and advised to rest. The report stated that giving a patient aldomet at this stage “is a waste of time.”
According to the report, Dwarka-Bowlin pushed through an undilated cervix at 23.38 hours (delivering a baby boy).
It also added that the patient was not monitored during labour.
The report stated that at around 05.30 hrs, Bowlin’s condition deteriorated. However, though she needed a transfusion, no blood was available at the Skeldon Hospital. She became unconscious, and ceased to breathe at 05.40 hrs. A post-mortem showed that Bowlin died from internal injuries.
In a section of the report marked ‘questions’, queries were raised as to why no ultrasound was done on the patient.
Cabinet Secretary Dr Roger Luncheon has since summoned officials from the Skeldon Hospital to appear before a special Cabinet sub-committee, to explain the circumstances that led to Dwarka-Bowlin’s death.
The review on the death of 15-year-old Nadira Sammy of Number 69 village, Corentyne, stated that she had 15 ante-natal clinic visits at the Skeldon Hospital.
She was referred from Skeldon Hospital and admitted on September 16 to New Amsterdam Hospital at around 14.05 hrs.
No vaginal examination was done because the patient was not complaining of abdominal pains.
According to the report, at around 21.25 hrs that night, the teen was seen by the consultant. This was some seven hours and five minutes after she was admitted to the institution.
The report said that the teen subsequently developed shortness of breath. Her condition deteriorated and she ceased to breathe. She passed away before delivery.
A post mortem report stated that Nadira Sammy died from cerebral haemorrhage and eclampsia (a condition that causes seizures or coma in a patient).

Esther Dwarka-Bowlin

Yogeeta Bisham

Under the section marked ‘questions,’ the report queried why the consultant was not informed about Sammy when she was admitted to hospital. It also stated that there was a delay in the management of the patient for Pregnancy Induced Hypertension. According to the report, the junior doctor who treated the teen failed to recognise the signs of imminent eclampsia and inform the consultant.
“Protocol of care was not adhered to,” the report concluded.
The report on 27-year-old Rebekah Chinamootoo (called Rebekha Seegobin in the report), of Number 36 Village, Corentyne, said that she attended the ante-natal clinic on four occasions
She was described as a high risk patient. She was admitted to the New Amsterdam Hospital on September 16 at 08.25 hrs. She had a history of lower abdominal pain.
According to the report, a junior doctor directed that the patient be given buscopan, which is used to treat intestinal spasms and stomach cramps. The report stated that Seegobin refused treatment and signed a self-discharge form and left the hospital. The report said she was readmitted to the hospital at 18.35 hours.
After the patient failed to have a normal delivery, the Consultant ordered that Seegobin undergo a Lower Segment Caesarean Section. The surgery was completed at 17.00 hrs and Seegobin delivered a baby boy.
At 17.05 hrs, Seegobin was shown to have an “altered level of consciousness” (a semi-comatose state). No blood pressure was recorded.
There was also haemorrhaging in the uterus.
According to the report, the consultant removed clots and ordered blood to be given to the patient.
However, Seegobin eventually succumbed.
The report on Heerawattie Bisham, 21, (also called Yogeeta Bisham) said that she joined the antenatal clinic 18 weeks into her pregnancy. She had 12 antenatal visits to the Skeldon Hospital clinic.
Seegobin was admitted to the New Amsterdam Hospital on October 20 at around 06:00hrs, with a referral from the Medical Doctor at Skeldon Hospital. She had a history of spontaneous delivery and a blood loss of 800 mls.
It said that the uterus contracted but the patient was still bleeding and was “very uncooperative and not allowing examination of the cervix.”
The report said that when Bisham arrived at the New Amsterdam Hospital at 06:00 hrs, her pulse was weak and ‘thready’, her extremities were cold and clammy and she was not responding to touch.
There was profuse bleeding from the vagina, she had no blood pressure and was in a state of hypovolaemic shock (caused by the severe blood loss). She was received by a consultant/ obstetrician and a junior doctor, anaesthetic nurse and doctor.
However, the patient succumbed despite all efforts to revive her.
A summary of the report questioned whether the Skelton and New Amsterdam Hospitals were adequately prepared to deal with such emergencies. It suggested that nurses need to allow doctors to decide what drugs a patient should be given and not administer the medication themselves.
“Nurses need to call doctors promptly when there is an emergency. Delays lead to poor outcomes.”
It also noted that “standards of nursing care need immediate intervention by the General Nursing Council.”
The report also said that junior doctors needed to be mentored in obstetric emergencies.
In Skeldon and New Amsterdam Hospitals, both junior doctors could not recognise signs of imminent eclampsia.”
“Junior doctors cannot be allowed to work unsupervised in a hospital. Continuous training is needed on the job for these junior doctors.”
The report also noted that the care was “fairly good” at the antenatal clinic, but in two cases the patients could have joined earlier. It suggested that every pregnant woman admitted to the labour ward must be seen by the doctor and any deviation acted on promptly
It added that blood products should be available on a 24-hour emergency basis at the district and regional hospitals. “Ambulances must be in place at the district hospital which offers deliveries so that in the event of an emergency there would be no delay in getting to a higher level of care. In a resource-limited and challenging regional sector, the shortage of skilled midwives and specialized staff (obstetrician) compounds the vulnerable situations. There is need to relook at the placement and allocation of midwives on the night shifts.”
Meanwhile, a report is still due on 40-year-old Registered Nurse Charlene Amsterdam, who succumbed last month at the Georgetown Hospital, two days after delivering a baby girl.
Amsterdam, of Q 79 Samon Street, Tucville, and of Amelia’s Ward, Linden, died sometime around 03:15hrs on October 24 at the GPHC, after undergoing a caesarean section.

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