Despite a series of assurances about impending “improvements” in cardiac care at St. John’s Hospital at Howden, in late July the hospital was once again left without on site cardiac cover.
True, there was some “visiting” cover from other hospitals, but was this enough, and is the ongoing farce in relation to the provision of this vital service at St. John’s truly equitable, as NHS Lothian Board members would have us believe? Well, let’s look at their own evidence.
In 2002 the highly respected cardiologist, Dr John Irving, retired. That left just one single-handed specialist, Dr Ashok Jacob, who in addition to his role in cardiology also works in general medicine. For years we have lamented the departure of Dr Irving, and the continued failure of NHS Lothian to replace him. Single-handed specialisms are widely criticised as “unsafe”, but this still didn’t speed up the process to address the inadequacy of cover at St. John’s.
Not that it wasn’t agreed that something should be done. No, those in power acknowledged it, and then chose to do nothing about it. In March 2008, during discussions about the job re-design of the sole remaining cardiologist at St. John’s, Dr Ian Starkey, NHS Lothian’s then head of cardiology, stated that he had sympathy for the proposition that St. John’s needed another cardiologist. So much so, that he arranged for himself and a colleague to spend three months each at St. John’s in early 2009 to enable them to make a determination.
Of course, their posts at Edinburgh hospitals were immediately backfilled by locums during their sojourn to St. John’s. Heaven forefend that Edinburgh hospitals should be left with just eleven other cardiologists, even temporarily!
Having carried out this visiting assessment, the conclusion was reached in July 2009 that St. John’s did indeed need a further cardiologist, and the then Chief Executive of the University Hospital’s Division, Mr James McCafferey, said so.
So what has been the outcome? The silence was deafening until the meeting of the Board in March, only revealed to us through the minutes of that meeting published in May. At the meeting in March, Dr Andrew Flapan made a presentation about the re-design of cardiology cover within the Lothians.
Did St. John’s get its new cardiologist, repeatedly identified as being necessary, and supported by Mr. McCafferey?
No, what it got was a commitment to have a nameless doctor "visiting" at various random times for an hour every day! When even this inadequate service couldn't happen then there would be "someone on the end of a telephone".
Equity of service? No, another slap in the face for West Lothian and St. John’s. What makes this current situation all the more extraordinary is the contribution of NHS Lothian Chief Executive Professor James Barbour at the meeting. He now seems to have recognised that what we have been saying for years about single handed consultants was correct: it isn’t safe, nor is it “equitable”.
The volte face is all the more extraordinary when you consider the fact that this Board sacked a staff nurse at St. John’s in 2008 for daring to question the eponymous Dr. Flapan’s egregious contribution to the cardiology debate in the West Lothian media. These mild mannered souls also had the temerity to accuse Councillor Gordon Beurskens of “bullying” Dr. Flapan, a complaint subsequently thrown out by the Standards Commission.
This isn’t another tirade at the expense of the Board: it is a cold assessment of what has happened over the past 8 years, and the iniquitous treatment of West Lothian patients which continues apace.
Compare the miniscule cardiology service provided for West Lothian at St. John’s with the 2 other "acute” Lothian hospitals in Edinburgh. At the Western General, a cardiologist retired in March. He was immediately replaced by a locum and the post was filled within weeks.
The WGH has three cardiologists on site, one of whom does general medicine. In addition, they have at least one full-time cardiology registrar, a second one who does clinics and at least six visiting cardiologists from the Royal Infirmary.
At the Royal Infirmary, a phalanx of cardiology consultants and registrars preside over a service run from what is now recognised as one of the most damagingly expensive publicly funded building projects in Scottish history.
A recent presentation on cardiology to the Board, CHCP and the St. John’s Hospital Stakeholders Group has highlighted the nub of the problem.
Dr Flapan rightly maintains that specialist cardiology procedures need to be centralised to ensure that skills are maintained at the highest levels. He also rightly asserts that efficient use of staff has to be maintained to deliver the best service to all patients in the Lothians.
This has been widely recognised since Private Eye revealed the scandal of mortality rates in paediatric cardiology treatment at Bristol in 1992.
So there is nothing new here. But what does appear unusual is that cardiology re-design in Lothians, by Dr. Flapan’s own statements, began on 7th. July 2007.
The subsequent decision to "forget" the inconvenient truth of Dr Starkey’s comments, and just assign some hotchpotch clinical sessions to a visiting cardiologist is simply not enough.
What is conveniently ignored here is the benefit of proximity. We accept that technology has progressed significantly and remote patient assessment, and even limited diagnosis, can be done by remote telemetry. But that doesn’t address all the emergency and routine cardiology situations an acute receiving hospital is likely to face.
The benefits of proximity are benefits restricted to RIE and WGH, and St. John’s is just the poor relation.
And this is NHS Lothian's idea of equity.
We have another name for it: DOWNGRADE. And we will continue to shout it from the rooftops until those in power at Holyrood decide to take notice of those who put them there, in return for which they have had to witness an impotent administration, despite their assurances to the contrary, allowing the decimation of acute life threatening services to continue.
Work on the campaign has continued throughout the summer months and we hope to see you all at the forthcoming meeting where we will update you on this work and developments which have taken place.
Our web site has been updated with recent articles which have appeared in the press in relation to St John's, and the comments page also updated with letters we have received. These can be viewed at our usual website address which is www.stopthedowngrade.org
Please continue to support your local hospital. We hope to see you on 13th October in the Kaim Park.
Regards,
The SDC Team
