Closure of Lewisham ICU – where’s the evidence?

Matthew Kershaw, the Trust Special Administrator for the now dissolved South London Healthcare Trust (SLT), is making recommendations under the ‘Unsustainable Providers Regime’ that will result in the closure of the Lewisham Intensive Care Unit (ICU). Some closures are inevitable, but is this one based on evidence or simply cost cutting?

Lewisham ICU expanded in December 2006 into a combined ICU and High Dependency Unit (HDU) in a State of the Art facility in the new Riverside building, providing up to 21 patients with their own bay. It has space for an additional 3 ICU and 3 HDU beds and could provide a significant proportion of the services currently provided within SLT.

The Borough of Lewisham contains some of the most deprived wards in England. Deprivation is known to make severe, complex illness more likely. Despite this, Lewisham ICU is one of the better performing ICUs in the country (www.ICNARC.org). The standardised mortality ratio (SMR) is used to measure performance and quality of care in ICUs in England, and results consistently show that a patient admitted to Lewisham ICU is significantly more likely to get better than a patient admitted to a unit representative of the national standard of care

Lewisham’s ICU takes critically ill patients from all over London. In the last 12 months the ICU/HDU has looked after 772 patients at 94.9% capacity, with 34.8% on full life support and 12.6% requiring renal support. Kershaw’s current recommendations result in the net closure of 6 fully funded ICU and 8 fully funded HDU beds in South East London. No consultation with the critical care staff has taken place. Within Europe, the UK already has the smallest proportion of acute hospital beds allocated to critical care with 3.5 beds per 100,000 people. Germany has 24.6 per 100,000 and the US has 20 per 100,000.

Lewisham is the only DGH ICU in London that has been recognised by the Faculty of Intensive Care Medicine (FICM) as of sufficient quality to train the intensive care doctors of the future. It provides a consultant intensivist led outreach service that provides daily review, advice and expertise to all the other specialties to help recognise and initiate the prompt treatment of patients who may be deteriorating in the hope that we can stop them needing intensive care at all.

Lewisham ICU also conducts regular patient, relatives and staff wellbeing surveys. The responses are universally positive responses and these results have been presented at international meetings. The physiotherapists, pharmacists, nutritionists, speech therapists, radiographers, clerks, cleaners, 66 nurses, 9 doctors in training and 7 consultant intensivists have worked hard to deliver a truly excellent service serving such a deprived area, and understandably don’t want their service to be shut down.

The biggest challenge for those overseeing the current wave of NHS reorganisations is to provide robust evidence to those whose services are going to be disrupted, downsized or closed that the new service will be better. This has undoubtedly happened with the reorganisation of stroke care in London, partly because it was properly planned, consulted on and coordinated. SLT became a financial disaster in part due to two ridiculously unaffordable PFI developments, and the fear is that high quality services may now close. A final report will land on Jeremy Hunt’s desk in January.