The Rt Hon Matt Hancock MP
Secretary of State for Health and Social Care
39 Victoria Street
London SW1H 0EU
Your Ref: TO – 1156976 8th December 2018
Dear Secretary of State
Dorset residents implore you to attend to the evidence of 396 residents at potential harm, and 183 residents likely to die, every year, if the plans to downgrade Poole A&E and close Poole Maternity go ahead
Thank you for the letter that our Residents Group has received, dated 4th December, and written on your behalf by Christian Brinsden. However we were very surprised that Mr Brinsden’s response did not mention our core concern: the evidence of 396 Dorset emergency ambulance patients at potential harm, and 183 Dorset emergency ambulance patients likely to die, every year, should these plans go ahead.
We write again to implore the Secretary of State to either refer the plans for full review by the Independent Panel, or to provide medical assurances in relation to each of the cases in the table of likely Dorset fatalities below, and ensure that an independent and full clinical risk assessment is carried out.
Dorset CCG has not properly attended to the known risk to residents. They have been unable to provide the specific assurances and indeed have not done the work that the South West Ambulance Trust call for in their Report* (page 2, 1.6) to assess the extent of the ‘potential harm’ to the 396 patients.
“Dorset Clinical Services Review: Modelling the Potential Impact on the Emergency Ambulance Service” https://www.dorsetsvision.nhs.uk/wp-content/uploads/2017/09/swast-report.pdf
Dorset CCG themselves provided the evidence to the High Court that 132 emergency ambulance patients over the 4 months of the Ambulance Trust Report, or 396 patients over a year, would be at potential harm. We attach the CCG’s own calculation for the Court.
As stated Dorset CCG has not done the further work called for by the Ambulance Trust to assess the extent of risk to these patients. However, it is evident that for many of the cases in the Report the likely consequence, had they not been able to be treated at Poole Regional Trauma A&E and Specialist Maternity last year, and had to travel further to access services elsewhere, was fatality. Cases include a child post cardiac arrest, an unresponsive child who would have faced a 9 minute longer journey, a mum-to-be with ectopic pregnancy in extreme pain with internal bleeding and fatally low blood pressure, who would have faced a 19 minute longer journey.
A Dorset A&E Dr has reviewed the cases in the Ambulance Trust Report and assessed that just under half were in imminent danger of dying, so that any longer journey was likely to prove fatal. This scales up to 183 likely fatalities per year.
We ask the Secretary of State to attend to the multiple likely resident fatalities.
Likely Dorset fatalities = 183 per year of those transported by Ambulance
if Trauma A&E & Specialist Maternity Services are lost at Poole
Taken from the Ambulance Trust Report, which looked at emergency patients taken to Hospital by ambulance over the period January-April 2017
For Maternity cases see p10, for Adult cases pp15-16, and for Paediatric cases p24.
|
Diagnosis
|
Maternity Paediatric
Or Adult
|
Details
|
Extra Journey Mins
|
Potential Harm
|
|
Overdose non opiate
|
Adult, 90
|
Overdose zopiclone and paracetamol
|
21
|
Yes – reducing Glasgow Coma Scale (GCS) and difficult airways management
|
|
Sepsis
|
Adult, 95
|
Chest sepsis – aspiration
|
21
|
Yes – red flag sepsis with shock, Glasgow Coma Scale 3, peri-arrest, 21 extra minutes without antibiotics
|
|
Haemorrhage
|
Adult, 91
|
Large rectal bleed
|
20
|
Possible large PR bleed, hypotensive and becoming shocked
|
|
Overdose – unspecified
|
Adult, 42
|
Mixed overdose
|
18
|
Possible – fluctuating Glasgow Coma Scale requiring airway intervention
|
|
Overdose – unspecified
|
Adult, 49
|
Unresponsive
|
17
|
Yes – airways management difficult
|
|
Trauma
|
Adult, 33
|
Knocked over by car? Knocked out.
|
14
|
Yes – agitated and dropping Glasgow Coma Scale
|
|
Diarrheoa and vomiting
|
Adult, 82
|
D&V sepsis
|
14
|
Yes – very hypotensive despite fluids
|
|
Sepsis
|
Adult, 83
|
Chest infection – likely sepsis
|
14
|
Yes – red flag sepsis with shock, Glasgow Coma Scale 6, peri-arrest, extra minutes without antibiotics
|
|
Stroke
|
Adult, 85
|
? Cardio-Vascualar Aneurysm
|
14
|
Yes – increased travel time with unconscious patient needing CT scan
|
|
Neurological
|
Adult, 84
|
Cerebro vascular event (CVE) haemorrhaging
|
9
|
Yes – Reduced Glasgow Coma Scale with possible CVE event
|
|
Stroke
|
Adult, 89
|
?Stroke or TIA – mild improvement
|
9
|
Yes – confirmed cerebro vascular event although still within window
|
|
Cardiac arrest
|
Adult, 76
|
Cardiac arrest after ambulance arrived
|
4
|
Possible, difficult to do CPR in moving ambulance for further minutes
|
|
Haemorrhage after birth
|
Maternity
|
No pulse improved en route
|
9
|
SWAST left blank
|
|
Ectopic pregnancy
|
Maternity
|
Extreme hypotension systolic bp 66mHg, pain score 10/10
|
19
|
SWAST left blank – bleeding into abdominal cavity causing fatally low blood pressure and extreme pain
|
|
Multiple Convulsion
|
Child
|
Child remained Glasgow Coma Scale 3
|
9
|
SWAST left blank – Glasgow Coma Scale 3 = unresponsive
|
|
Cardiac Arrest
|
Child
|
Post cardiac arrest
|
4
|
SWAST left blank
|
|
Medical
|
Child
|
Very sick child
|
4
|
SWAST left blank
|
Please note that 396 per year at potential harm and 183 per year likely to die is an underestimate. We provided FOI evidence to the Secretary of State that Poole A&E saw 590 maternity emergencies last year. 456 of these (77%) did not arrive by ambulance. The majority of child emergencies and a significant minority of adult emergencies do not attend by ambulance either.
No risk assessment at all has been carried out for these patients.
Mr Brinsden’s letter did not address the fact that there are a range of time critical conditions that cannot be treated in the Ambulance, where time to Hospital is a matter of life and death.
The Judicial Review Claimant has sought leave to Appeal. The Judicial Review can only consider the process Dorset CCG followed in making their decisions. The Judicial Review can not consider whether the decisions are right for residents. This is the responsibility of the Scrutiny Process.
Dorset residents look to the Scrutiny process to properly attend to the known risk to our lives.
We implore the Secretary of State to refer the plans for full review by the Independent Reconfiguration Panel.
Otherwise we request that the Secretary of State:
· Asks for medical assurances to be provided in relation to each of the ambulance patients in the table above who have were assessed as likely to have died had they been unable to access Poole Trauma A&E or Specialist Maternity facilities, January-April last year.
· Asks for a full independent clinical risk assessment to be carried out. This would involve assessment of the 696 adult cases identified as likely to face potential harm, as the Ambulance Trust only looked at 150 of these cases, and assessment of the risk to the non-ambulance emergency patients who arrived at Poole, January-April last year.
Yours sincerely
Debby Monkhouse
On behalf of Defend Dorset NHS Residents Group
