Allowing Lewisham to retain its A and E would help to reduce the level of increased demand at hospitals with larger A and E services, while an additional £37 million of investment will further expand services at these hospitals for more serious conditions. Sir Bruce advised that patients with those more serious conditions should now be taken to King’s, QE, Bromley or St Thomas’s—not for financial reasons, but to increase their chances of survival.

On the issue of paediatric care, Sir Bruce recognised the high-quality paediatric services at Lewisham and that any replacement would have to offer even better clinical outcomes and patient experience. His opinion is that this is possible, but dependent on very clear protocols for primary ambulance conveyance, a walk-in paediatric urgent care service at Lewisham, and rapid transfer protocols for any sick children who would be better treated elsewhere. He is clear that this will require careful pathway planning and will need to be a key focus of implementation.

With these 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.