We, doctors in Lewisham, have grave concerns about the proposal to downgrade emergency medical and surgical services at Lewisham Hospital made by the Trust Special Administrator (TSA) for South London Healthcare NHS Trust. Lewisham Hospital is not part of that trust. It is a solvent, successful organisation that delivers high-quality care to its patients. Yet the TSA has taken the extraordinary view that Lewisham’s Accident and Emergency Department should close to admissions, leading to closure of acute services including full maternity services, and that most of the hospital site be sold. 

Emergency services are vital for the population of Lewisham, which contains some of the most deprived wards in England. Lewisham Hospital’s new £12 million A&E department opened as recently as April 2012 in response to the need for expanded services. The TSA’s report asserts that the need for emergency care would be reduced by 30% simply by providing more care in the community. However, there is simply no clinical evidence to back this up. In any case Lewisham Hospital has already been innovative in working with social services to provide more care at home and avoid admissions in patients with chronic illness. Our intensive care unit has excellent standardised mortality rates. Our new birthing centre has high maternal satisfaction and provides high-quality care to a community with a high proportion of ‘high risk’ births, which would be jeopardised if maternity services are lost or downgraded. Lewisham Hospital features in the top 40 hospitals in the CHKS rankings. It its acute services are lost, they could not be provided by others without risking patients' safety and quality of care. 

 The TSA’s review fails the “four tests” that you and the Secretary of State for Health have recently laid down in Parliament. It does not have the backing of GPs. It does not have public support, as the demonstrations, public meetings and the petition have shown. It is not based on sound clinical evidence (detailed responses from groups of clinicians, including GPs, are at http://www.savelewishamhospital.com/). Even the report itself acknowledges that it will not improve patient choice. 

 Your government's response to this report has an importance beyond Lewisham. The report is an attempted regional reconfiguration, tacked onto the statutory regime for an unsustainable provider, which is being used here for the first time ever. The report was drawn up to statutory timescales that are much too short for a considered reconfiguration, with the result that the clinical consultation is desultory and the clinical evidence is of poor quality. If this report is accepted as it stands, it will create a dangerous precedent for the rest of England. Furthermore, the TSA has produced a report which perversely recommends that a solvent and successful organisation be punished to save a separate, unsustainable provider. We doubt that this is a signal that you will want to send to the NHS and the public. 

We urge you and the Secretary of State for Health to reject the recommendation that Lewisham Hospital lose its A&E and acute services.