Pre-Consultation Documents and Activity
Initial announcements and meetings, August 2005 to January 2006
Two children started at the Nuffield Unit in September 2005 with the expectation of staying on for a two-year period. The other 8 children currently attending were all expected to leave the unit at the end of the 2005 academic year (i.e. in June / July 2006). The parents of the two new starters were informed by Mr Denis Taylor (Divisional Director of the Royal National Nose, Throat and Ear Hospital) in August 2005 (i.e. before the start of the school year) that the Nuffield unit was expected to become financially un-viable in the near future, and that a review of its future was being carried out. A copy of Mr Taylor's original letter can be viewed here. Mr Taylor said that he would be willing to meet with the parents of the two new starters individually to discuss the situation. Parents of children already attending the unit were not informed about the situation until after the start of term, and then via a short note written by Claire Wright, head teacher of the Nuffield Unit. No offer of meetings with the hospital management was made to these parents.
Both sets of parents of the new starters met with Mr Taylor individually. Notes from one of these meetings were written up and sent back to Mr Taylor, who subsequently confirmed them as accurate.
At the strong insistence of parents, Mr Taylor agreed to organise some public meetings, although Mr Taylor stated that the though such meetings would serve no purpose. One meeting was held at the Nuffield unit on November 11th, and a second was held at the Royal National Throat, Nose and Ear Hospital in London on January 17th 2006. These meetings were attended by Mr Way, Mr Taylor, some (but not all) of the staff of the Nuffield Unit, the consultants and speech and language therapists from the Nuffield Hearing and Speech Centre, parents of children attending the unit and parents whose children attended the unit in the past.
Mr Way informed the meetings that the Royal Free Hampstead NHS Trust board would consider a paper prepared by Mr Taylor concerning the Unit in which closure of the unit was recommended as the only sensible option. Mr Way said that he believed that the Board would recommend closure of the unit and that, since a withdrawal of a significant NHS service was involved, a consultation period lasting 3 months would then begin during which the RFH NGHS Trust would seek opinions from stakeholders.
Mr Way also re-stated the fact that the RFH has a large debt and that no part of its operations would be allowed to operate at a financial loss (even temporarily). Mr Way saw no possibility for making the Unit financially viable and stated (as had Mr Taylor before) that the Trust had no resources available with which to raise awareness of the unit amongst potential users or health professionals who might make referrals.
Mr Way stated that Mr Taylor had been in contact with Local Education Authorities (LEAs) who had in the past sent children to the unit to find out if they had any intention of using the Nuffield Unit in the future. Mr Taylor had received responses indicating that LEAs would prefer to use their own local provisions.
Parents pointed out that the responses received from LEAs were only to be expected given the unspecific nature of the questions that had been put to them. Parents stated that these same LEAs had a statutory duty to make adequate provision for children with severe and complex speech and language difficulties, and that since it was universally acknowledged that no other facility exists within the South East that can match the therapy available at the Nuffield Unit, the LEA responses could not be taken as evidence for a lack of demand for the Unit's services.
Mr Taylor admitted that he had received many letters of support for the Unit, but Mr Way dismissed these as being mostly from private speech and language therapists. Parents had also raised a petition containing 743 signatures (since risen to over 860) opposing the closure of the Unit; this was acknowledged to be a significant number for such a small unit. The petition was handed to Mr Way, and also copied to Members of Parliament.
Parents were universally of the opinion that the Unit should be granted a “stay of execution” during which alternative means of saving the unit could be investigated, and parents offered to help in this effort. Mr Way would not consider any such scheme unless the Royal Free Hampstead NHS trust could be assured on not making any financial loss. It should be borne in mind that the annual running cost of the Nuffield Unit is estimated to be some £383,000, all of which would normally be covered by fees paid by LEAs and Primary Care Trusts (PCTs); this figure must be compared to the annual turnover of the Royal Free Hampstead, which is estimated to be some £175,000,000 and the scale of the Trust's debt, which is some £18,000,000. The Nuffield unit is only a small operation.
It was pointed out parents that the unit had been full and even over-subscribed over the past five years at least, even to the extent of turning away children with agreed funding only the previous year. This was confirmed by one of the consultants who stated that the Unit had made a net financial contribution to its parent hospital. It was also pointed out to Mr Way that there was no evidence of a decline in the number of children suffering from severe speech and language difficulties (in fact, improved mortality amongst premature babies implies quite the opposite). Mr Way agreed with this point. Parents then speculated that the unit might be returned to profitability and might even be expanded in the future if only the correct remedial action could be put in place in the short term. It was thought that the unit might be is a very strong position in future, especially given the changes in opinion that are currently occurring amongst special educational needs policy makers.
The point was made very strongly that the expertise and experience contained in the unit could not be replaced should the Unit be closed, and that not only the children currently in the unit would suffer, but also the children presenting in the future.
During the second meeting an idea was raised to the effect that the RFH Charitable Trust, which owns the building in which the Nuffield Unit is housed, might agree to underwriting the operation of the Unit for a year whilst remedial action is taken. The RFH NHS Trust would seek a guarantee that any losses it might incur would be re-paid out of the proceeds of selling the buildings should the Unit close.
RFH NHS Trust Board Meeting, January 2006
Mr Taylor prepared a paper for presentation to the Royal Free Hampstead NHS Trust board meeting to be held on January 26th 2006. Prior to the presentation, parents had sight of the paper and pointed out that it contained several factual inaccuracies. It was also pointed out that the paper failed to present the situation of the unit in an un-biased manner and that it was heavily prejudiced towards the closure of the unit, without having investigated alternatives to a sufficient extent. These points were put to Mr Way and to Mr Taylor, and parents prepared a modified version of the paper which, whilst retaining the original structure as far as possible, sought to correct the factual errors, to balance the arguments and to suggest some alternate courses of action.
The original paper was modified slightly by the addition of an addendum which arose from the last of the two meetings with Parents. This paper was presented to the Royal Free Hampstead NHS Trust Board at its meeting of January 26th 2006.The changes suggested by parents were largely ignored and the modified paper was not presented to the Board.
Minutes of the Board Meeting (approved at the meeting on March 23rd 2006) can be obtained from the Royal Free Hampstead NHS Trust's web site, or directly from here.
The Board decided that it could not agree to the continued funding of the Nuffield Unit in light of its current financial situation. It agreed to ask the Charitable Trustees if they would be willing to underwrite the cost of the unit for a further year. The Board also considered a plan to ask the Charitable Trustees to fund a short research project to ascertain the likelihood of further referrals to the Unit; nothing more has been heard of this proposal.
The charitable trustees met in private to consider the requests put to them by Mr Way. No minutes are available. The conclusion of the meeting was communicated in a press release dated February 2nd 2006 put out by the Royal Free Hampstead NHS trust.
The press statement says that the Charitable Trust did not think that sending up to £250,000 on 2 to 4 children was the best use of their funds. This statement ignores the point made by parents that underwriting was being sought not only for the children currently attending the unit, but to preserve the unit for future generations of disabled children. Details of the charitable trustees may be obtained from the Royal Free Hampstead NHS Trust web site, or via the links provided on this page. It is noteworthy that the trustees receive advice from Andrew Way, that the Chair of the Trustees is also the Chair of the NHS Trust Board, and that the Treasurer of the Charitable Trust is also the director of finance for the RFH NHS Trust.