Lewisham A&E survives – why?

Matthew Kershaw had put together recommendations for delivering safe, high quality, affordable and financially and clinically sustainable health services for people previously served by the South London Healthcare NHS Trust and across south-east London. The recommendations were not a pick-and-mix list; they were developed to be taken as a whole to stop the haemorrhaging of money out of the NHS and ensure the people of South East London have the best clinical care possible for years to come. Matthew could no more consider SLH NHS Trust in isolation than a doctor can consider one symptom without looking at the body as a whole.

Everyone across South East London deserves the best possible services and Jeremy has made the right decision on all but one of Matthew’s recommendations. On Lewisham Hospital A&E however, he is sadly delaying the inevitable and costing the taxpayer more. In an economy in which national debt continues to rise, to choose a solution that increases financial risk and debt is regrettable. It’s all very well intending the A&E to be smaller and focus on older people, but the reality is that people use their local A&E as an alternative to their GP and attendance across the country rises year on year. Added to this in North London commissioners are trying to close the smaller A&Es. If it remains open, people will use it as before. Unfortunately sentimentality and politics have left us with a solution that is unsustainable in the long-term and will have to be revisited yet again in the future.

That said, the other thing that will change is that local GPs are now involved in commissioning services and holding the budget. It is expensive for their patients to attend A&E so there is a strong incentive for them to ensure Lewisham A&E is used appropriately. Over time they themselves could see the benefit of reducing services at Lewisham, which they may be able to do without a major outcry. After all, it will only be by working with patients as partners that ill health can be prevented in the first place and  quality of care will improve.