Statistical and clinical evidence for Jeremy Hunt's claims r.e. Lewisham Hospital

S Hawthorne made this Freedom of Information request to Department of Health

Department of Health did not have the information requested.

From: S Hawthorne

3 February 2013

Dear Department of Health,

On 31 January 2013, the Secretary of State for Health approved the
downgrade of Lewisham Hospital's accident and emergency department
to a "smaller" A&E and the downgrade of the hospital's maternity
unit to a mid-wife lead unit.

A number of claims were used to underpin this decision. I would
like to request the statistical and clinical evidence behind each
of the below statements:

1) The changes to maternity and emergency care would result in the
average blue light transfer times in south-east London increasing
by one minute

2) Accessing consultant-led maternity services will involve an
increase in journey times on average of two to three minutes by
private or public transport

3) The new free-standing, midwife-led unit at Lewisham Hospital
will be able to deal with a minimum of 10% of existing activity and
up to 60% of current activity.

4)The new smaller Lewisham Hospital A&E can continue to see up to
75% of those currently attending Lewisham A&E

5)The overall proposals could save up to 100 lives per year through
higher medical standards

I look forward to receiving the information used to underpin the
above five statements. If you are unable to provide this
information, I would be grateful if you could direct this request
to the appropriate individual/organisational body.

Yours faithfully,

Shannon Hawthorne

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Department of Health

5 February 2013

Thank you for contacting the Department of Health.
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Where a reply is appropriate, we aim to send one within 18 working days,
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response may have been published.

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References

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From: S Hawthorne

9 February 2013

Dear Department of Health,

Just to clarify r.e. my original request, I am well aware that many
of the points were taken from advice Mr Hunt received from Sir
Bruce Keogh and that the letter from Sir Bruce Keogh is available
online.

To be absolutely clear, what I am asking for, under the Freedom of
Information Act, is what clinical and statistical evidence Sir
Keogh himself based these assertions on.

In terms of the '100 lives saved' claim, which Mr Hunt did not get
from Sir Keogh, I would like to know what clinical and statistical
evidence Mr Hunt based this assertion on.

I hope this is clear.

Yours faithfully,

S Hawthorne

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From: S Hawthorne

27 February 2013

Dear Department of Health,

With two more days until you are legally required to make a
response, just to make my request unequivocally clear, I am asking
for the statistical and clinical evidence that was used by either
Bruce Keogh or (in the case of the 100 lives claim) Jeremy Hunt, to
come to the exact figures stated in my original request.

I am not asking you to direct me to general research on A&Es that
was used to support to decision to downgrade the hospital - I want
to know the details of the specific calculations that led Bruce
Keogh / Jeremy Hunt to these EXACT figures.

To confirm, these figures are (capitalised for emphasis):

1) The changes to maternity and emergency care would result in the
average blue light transfer times in south-east London increasing
by ONE MINUTE

2) Accessing consultant-led maternity services will involve an
increase in journey times on average of TWO TO THREE MINUTES by
private or public transport

3) The new free-standing, midwife-led unit at Lewisham Hospital
will be able to deal with a minimum of TEN PER CENT of existing
activity and up to SIXTY PER CENT of current activity.

4)The new smaller Lewisham Hospital A&E can continue to see UP TO
75% of those currently attending Lewisham A&E

5)The overall proposals could save up to 100 LIVES per year through
higher medical standards

Yours faithfully,

S Hawthorne

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From: S Hawthorne

2 March 2013

Dear Department of Health,

You were legally obliged to respond to me yesterday. Please provide
a prompt response to my enquiry.

Yours faithfully,

S Hawthorne

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Department of Health

4 March 2013


Attachment Reply DE756987 Hawthorne.pdf
62K Download View as HTML


Our ref: DE00000756987 
 
Dear Ms Hawthorne,
 
Thank you for your FOI request of 4 February 2013.  I have been asked to
reply.

Please find the final response attached. 

Yours sincerely, 
 
Michelle Hinds
Freedom of Information
Department of Health
 

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From: S Hawthorne

3 April 2013

Dear Department of Health,

Please pass this on to the person who conducts Freedom of
Information reviews.

I am writing to request an internal review of Department of
Health's handling of my FOI request 'Statistical and clinical
evidence for Jeremy Hunt's claims r.e. Lewisham Hospital'.

My request stated:

“On 31 January 2013, the Secretary of State for Health approved the
downgrade of Lewisham Hospital's accident and emergency department
to a "smaller" A&E and the downgrade of the hospital's maternity
unit to a mid-wife led unit.

A number of claims were used to underpin this decision. I would
like to request the statistical and clinical evidence behind each
of the below statements."

I then listed five statements cited by Jeremy Hunt.

I later clarified that: “I am not asking you to direct me to
general research on A&Es that was used to support to decision to
downgrade the hospital - I want to know the details of the specific
calculations that led Bruce Keogh / Jeremy Hunt to these EXACT
figures.”

The description of the statistical and clinical evidence with
regard to two of the statements were vague, inadequate and
unacceptable. These statements were:

3) The new free-standing, midwife-led unit at Lewisham Hospital
will be able to deal with a minimum of 10% of existing activity and
up to 60% of current activity.

4) The new smaller Lewisham Hospital A&E can continue to see up to
75% of those currently attending Lewisham A&E.

The responses I received stated:

3) The National Institute of Health and Clinical Excellence suggest
up to 60% of women in England are suitable to give birth in a
free-standing midwife-led unit. However, based on historic patient
choice elsewhere in London, and an assumption that around half of
the patients currently using the co-located midwife-led unit at
Lewisham will continue to attend a stand-alone unit, the TSA has
modelled that around 10% of the births projected to take place at
University Hospital Lewisham in 2015/16 will still take place
there.

4) [Bruce Keogh’s] estimate that the site could manage nearer to
75% of activity with these changes is based on the Lewisham
Healthcare NHS Trust’s admissions data and flowing from this that
the A&E would have the clinical capacity to safely treat this
number of patients.

Neither response provides the exact calculations used to reach
these figures as requested in the FoI request. For clarity, I will
outline the information missing from the responses.

Question 3:

- “based on historic patient choice elsewhere in London” – what
historic patient choice is this referring to? Over what period?
What areas in London is this referring to? Where has this data been
sourced from?

- “and an assumption that around half of the patients currently
using the co-located midwife-led unit at Lewisham will continue to
attend a stand-alone unit” – what clinical and/or statistical data
is this assumption based on? Where has this data been sourced from?

- “the TSA has modelled that around 10% of the births projected to
take place at University Hospital Lewisham in 2015/16 will still
take place there” – what is the exact calculation used to reach
this figure? What are the underlying figures? This calculation
should be sufficiently detailed to clearly demonstrate how and why
the TSA reached this 10% figure, rather than, say, 5%, 8% or 15%.

Question four

“[Bruce Keogh’s] estimate that the site could manage nearer to 75%
of activity with these changes is based on the Lewisham Healthcare
NHS Trust’s admissions data”– what does this admissions data state?
How was this data used to reach the 75% figure?

- “and flowing from this that the A&E would have the clinical
capacity to safely treat this number of patients” – what clinical
and/or scientific data is this based on? Where was this data
sourced from?

Again, what are the underlying FIGURES used to reach the 75%
figure? I would like to know, under the Freedom of Information Act,
the EXACT calculation used by Bruce Keogh. This calculation should
be sufficiently detailed to clearly demonstrate how and why he
reached this 75% figure, as opposed to, say, 40%, 60% or 90%.

I trust that the Department of Health already has all this
information, or else the downgrade of Lewisham Hospital’s services
would never ever have been approved. As such, I look forward to a
speedy response.

A full history of my FOI request and all correspondence is
available on the Internet at this address:
http://www.whatdotheyknow.com/request/st...

Yours faithfully,

S Hawthorne

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From: S Hawthorne

8 April 2013

Dear Department of Health,

I would appreciate an acknowledgement of my request for an internal
review, and confirmation of when I can expect a response.

Yours faithfully,

S Hawthorne

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Department of Health

15 April 2013

Dear Ms Hawthorne

I understand that you have not received an acknowledgement of your request
for an Internal Review of your Freedom of Information request (Our
reference: DE00000756987).  We are not sure why this has happened and can
only apologise.

I can confirm that the Department has received your request.  This is
currently being processed by a member of the Freedom of Information team,
who will respond to you in due course.

Best practice on timeliness for IR responses is within 20 working days,
which means that, in this case,  we aim to respond to you by 2 May.

Yours sincerely,

Jamie Scott

Freedom of Information Officer
Department of Health

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Department of Health

30 April 2013

Internal Review of cases DE00000760490 and DE00000756987

Dear Ms Hawthorne

Thank you for your phone call this afternoon regarding the Internal Review
of your Freedom of Information request DE00000760490.

I am sorry that you have not received your Internal Review response within
the 20 day timeframe, which the Information Commissioner's Office
considers to be best practice. The Department aims to complete its
Internal Reviews within 20 working days but in some cases we do require
more time.

Our deliberations on both your Internal Reviews are continuing - please be
assured that we will aim to reply to case DE00000760490 by 7 May and to
case DE00000756987 as soon as possible

Yours sincerely,

Michelle Hinds
Freedom of Information Team
Department of Health

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Department of Health

1 May 2013

Internal Review of case DE00000756987

Dear Ms Hawthorne

I am writing to update you on the progress of your internal review request
of case DE00000756987.

Further to the email we sent to you yesterday, I am writing to confirm
that we will be unable to respond to your review request within the 20 day
timeframe, which the Information Commissioner considers to be best
practice.

Please accept our apologies for this delay. We will respond to your
request as soon as possible.

Yours sincerely,

Lynwen Paddy
Freedom of Information Team
Department of Health

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From: S Hawthorne

15 May 2013

Dear Department of Health,

Can someone please update me as to when I can expect to receive a
response. I assume I am not expected to wait indefinitely?

Given the decision to downgrade Lewisham Hospital was based on the
information I am requesting, I am surprised it is taking the
Department so long to source it...

Yours faithfully,

S Hawthorne

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Department of Health

22 May 2013

Dear Ms Hawthorne,

I would like to apologise for the time it has taken us to respond to your
internal review request, 756987R. I would like to assure you that we are
actively working on this case as a priority and will respond as soon we
can.

Whilst there's no legal requirement in the FOI Act to respond to internal
reviews within a specific time limit, best practice is to respond within
20 days.

In the vast majority of cases, we reply to internal reviews within 20
days. However, there are some cases that require more than 20 days to
consider and this is one of those cases.

Yours sincerely,

Lynwen Paddy
FOI Team

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From: S Hawthorne

22 May 2013

Dear Ms Paddy,

As stated several times on the phone, I am aware that the 20-day
limit is best practice guidance, not a statutory limit.

The Information Commissioner also states that:

"In view of all the above the Commissioner considers that a
reasonable time for completing an internal review is 20 working
days from the date of the request for review. There may be a small
number of cases which involve exceptional circumstances where it
may be reasonable to take longer. In those circumstances, the
public authority should, as a matter of good practice, notify the
requester and explain why more time is needed."

I have yet to receive any explanation as to the reason for the
delay. Could you please provide an explanation?

I would also like to draw your attention to the ICO's comment that:

"In our view, in no case should the total time taken exceed 40
working days."

I assume you're aware that it's now been 35 working days since I
filed the internal review request.

I look forward to a prompt response.

Yours faithfully,

S Hawthorne

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Department of Health

23 May 2013


Attachment 756987R final reply Hawthorne.pdf
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Dear Ms Hawthorne,

Please find atatched our reply to you internal review request, 756987R.

(See attached file: 756987R final reply Hawthorne.pdf)

Yours sincerely,

Lynwen Paddy
Senior FOI Manager
Freedom of Information Team
Email: [email address]

I work part-time - Wed to Fri

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From: S Hawthorne

23 May 2013

Dear Department of Health,

This response does not answer my question r.e question 4. I asked
for the clinical and statistical evidence used to come to the 75%
figure given by Bruce Keogh. This has not been given. If the DoH
does not have any such evidence, this should be explicitly stated
in the response.

Yours faithfully,

S Hawthorne

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Department of Health

23 May 2013

Dear Ms Hawthorne,

Thankyou for your further email of 23 May 2013.

I can confirm that the Department does not hold any further figures which
led to Sir Bruce Keogh’s estimate.  

Yours sincerely,

Lynwen Paddy
Senior FOI Manager
Freedom of Information Team
Email: [email address]

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