Controversal plans to remove the Intensive Care Unit (ICU) from Leicester General Hospital without a full public consultation have been met with mixture of shock and anger by the people of Leicestershire and Rutland, but also with serious concern from a group of academics.
In August 2018, a report was issued by Dr Janet Underwood and colleagues on the University Hospitals of Leicester (UHL) NHS Trust’s full business case for relocating level 3 intensive care beds and associated services from the General Hospital to Glenfield Hospital and the Leicester Royal Infirmary.
This article provides a summary of some of their findings.
Failure to Consult the Public
In 2015, when UHL first proposed their relocation plans, they convinced Leicester City and Leicestershire County Health Scrutiny Committees, which include elected councillors, to support their plans because it was clinically urgent and a perceived threat to patient safety.
Three years later, UHL are still justifying the removal of the ICU from the General on the same grounds of clinical urgency. Moreover, the matter should not have gone to individual health scrutiny committees but to a joint scrutiny committee which covers all the people of Leicester, Leicestershire and Rutland.
If the issue was patient safety in 2015, how have they been able to sit on these plans for three years? While there may have been good reasons for this delay, surely at some point during this time a full public consultation could have been carried out.
UHL’s plans are also potentially in breach of the law. As the report states: “English law demands that the public must be consulted before decisions and changes are made to National Health Services.” It continues: “the duty to consult the public formally and more extensively as required appears to have been sidestepped” by all concerned. This is despite the fact that the Trust “has had plenty of time to consult the public.”
Consulting the public is not just a formality, it is a critical part of ensuring plans are fit for purpose. The academic report highlights this problem when they state that “the lack of public consultation may have contributed to omissions and errors” that are contained in the current business case to relocate services.
One important and obvious problem in this respect is that the Trust’s business case does not include detailed information about their full plans for relocating other health services currently provided by the General, which are affected by the removal of Level 3 intensive care beds (these include kidney services, hepato-pancreato-biliary services and urology). The current plans split these services across two sites, posing a risk to continuity of care and possibly the quality of care.
UHL Plans Fall Short of Standards
The plans for the new renal transplant wards at Glenfield do not meet national building standards recommended by the Department of Health. For instance, toileting facilities are planned to be provided “on a ratio of 1 facility for 4 patients” when national standards recommend “a minimum of one shower with toilet and at least one separate toilet and wash basin in each bay – a ratio of 1 to 2 (i.e. one facility for two patients in a four bedded bay).”
These are not trivial matters. Preserving the dignity of patients should be high on the agenda of any proposed changes.
Another issue where the Trust’s plans fall short of the recommended standards is in relation to space. The report states: “Government planning and construction recommendations for hospital buildings will not be met as the Trust endeavours to incorporate too much into too small an area in order to contain costs.” Current plans for the relocation fail to meet Department of Health plans for 50% single rooms, with the Trust only planning to provide 30% single rooms; while the “improvement” plans for a so-called “super” intensive care unit at Glenfield will not even meet recommended spacing guidance. UHL’s proposals provide only 20 m2 to 23.9m2 per bed instead of the recommended 25.5m2.
For the report researchers these issues “raise doubts about the long-term fitness for purpose of the buildings” that are being invested in. They add that these deviations “appear to have resulted” from the Trust’s “position of having insufficient space to meet the required standards since the proposal is to build on top of existing buildings rather than on land which they wish to sell off.”
The Trust also “provides no justification for reducing” renal transplant beds from 14 beds at the General to 12 beds at Glenfield Hospital.
Paradoxically, while appearing to have insufficient space to build according to recommended standards, the plans include the sale of a large chunk of the General site for housing development and of land at the Glenfield Hospital site. These plans have not “been publicly debated and there are no details in the public domain of overall estate planning or details about how land values have been determined.” In a time when more, not less, public health service provision is needed – and will be needed in the future – selling publicly-owned hospital land for short-term gain runs the risk of leaving us with insufficient estate. (See this report by Health Campaigns Together for a detailed critique of the ongoing fire-sale of NHS land).
The public need more information to be able to make a judgement as to whether, overall, these plans are good for the people of Leicester, Leicestershire and Rutland.
Threat to the Leicester General
As made apparent in the local NHS Trust’s larger (at this stage draft) plans for Leicester’s three acute hospitals and in the Sustainability and Transformation Plan (STP) for Leicester, Leicestershire and Rutland, it has been known for some time that they aim to remove acute service provision from the General Hospital.
But to date the local NHS organisations putting together the STP have not published their finalised plans for these huge changes for the public, local campaigners and elected politicians to see. The local NHS have only committed to consulting on these changes at some unknown point in the future. But it is clear that if the Trust succeeds in relocating level 3 intensive care services away from the General Hospital (without consultation), then they will have pre-empted a later consultation as they will have already downgraded the hospital. Arguably it makes a future consultation on the fate of the Leicester General Hospital more of a ‘done deal’.
The report calls for both the Trust and the local Clinical Commissioning Groups to ensure the public are consulted.
(There are many other important issues raised by the report. For the full analysis, read the document posted at the end of this article.)
Join the Campaign
Save Our NHS Leicestershire is calling for a full public consultation into University Hospitals of Leicester’s ongoing efforts to remove the level 3 intensive care and associated services from Leicester General Hospital.
Public consultations represent a vital means by which hospital trusts and Clinical Commissioning Groups can present their arguments to the public, and the public can make their voices heard when it comes to the future of public services. It is our democratic right to have a say in the future of our services!
Come to the Save Our NHS Leicestershire public meeting on Saturday September 29 at “Hansom Hall, Leicester Adult Education College, Belvoir Street, at 14:00 to discuss how we can fight back against these proposals.
To read the full report released in August 2018 see “Report on University Hospitals of Leicester NHS Trust Full Business Case for relocating Intensive Care Unit Level 3 beds out of Leicester General Hospital”, authored by Dr. Janet Underwood, et al.