STRUCTURE: Senior clinicians from Lewisham Hospital have written to NHS medical director Sir Bruce Keogh to ask him to explain a statistic which Jeremy Hunt attributed to him about mortality at A&E departments.

The health secretary last week accepted the recommendations of the trust special administrator for South London Healthcare Trust that Lewisham hospital’s A&E unit be downgraded, subject to conditions.

He said he did this after been assured of the clinical benefits by Sir Bruce.

Mr Hunt told Parliament on Thursday: “With caveats, Sir Bruce was content to assert that there is a strong case that the recommendations are likely to lead to improved care for the residents of south east London and that they are underpinned by clear clinical evidence.

“He believes that overall these proposals, as amended, could save up to 100 lives every year through higher clinical standards.”

The 100 lives figure did not feature in a five-page letter Sir Bruce had sent Mr Hunt and that the Department of Health released last week (see attached).

Sir Bruce was asked to review the specific recommendations about services at Lewisham Hospital.

HSJ has asked the Department of Health what the figure was based on but has not yet received a reply.

The letter from the Lewisham clinicians (attached) said the number appeared to come from an NHS London study, first revealed by HSJ in September 2011.

This said 520 lives could theoretically be saved across London each year if mortality rates at the weekend were brought down to weekday levels.

The letter from Lewisham said: “A major weakness of the study is the lack of calculation of severity score of the presenting illness. This cannot be resolved without the source data. A proper analysis would also require the severity score at time of admission and the duration from point of admission to death.

“The fact that the daily emergency admission rate at the weekend is only 75 per cent of that during the week may well indicate that patients who present at the weekend are a sicker subset of those who present through the working week, with their more severe illness explaining their higher mortality.

“A second weakness is the assumption that higher mortality in patients admitted at the weekend results from a decreased level of staffing at the weekend. There are other explanations, including a reduced level of specialist intervention and access to diagnostic services at weekends. It is noteworthy that Lewisham Hospital has had a robust system of twice-daily consultant ward-rounds and access to out-of-hours diagnostics for eight years.”

It added: “The conclusion made by the secretary of state is therefore not founded on robust clinical evidence. It is troubling that such an unsafe conclusion could be used to make an assertion that has obviously influenced his decision, not just in the case of Lewisham Hospital but in general, that larger units will achieve better clinical outcomes.”