Jeff Williams a Poole Campaigner – open letter to Tim Goodson, Chief Executive Dorset CCG and Mr Goodson’s response

Dorset Clinical Commissioners : DCCG resorting to wholesale propaganda …

I note Mr Goodson DCCG has wrapped the Poole Herald in a four page wrapper.

Four pages of one sided propaganda. A whole catalogue of assertions – assertion after assertion all totally out of context and in that shockingly misleading.

I expect commercial propaganda from the commercial world. I didn’t think I would live to find the same propaganda coming from the agency we trust to manage our NHS.

What you list – clinical benefit after benefit – all fine but what we get are these improvements in half the hospitals where we need the improvements.

Dorset CCG is having to ‘save’ £158 million every year against what is needed for our services. And thus there are enormous cuts in services. Instead of two major hospitals for our 460,000 and rapidly expanding conurbation with full suites of all DCCG list – 24/7 urgent care units, separate full theatre 24/7 trauma A&E units, planned care departments, and full maternity – we get half of what we need with close down of Poole Trauma A&E and Poole leading and Specialist Neo-Natal Maternity, and five out of thirteen Cottage Hospitals in the County being closed down.

Close down of Poole A&E and Poole Maternity with loss of 400 beds and closure of five Cottage Hospitals – the sacrificial anodes in this operation to release the one-off £147 million capital investment predominantly for RBH with some investment in Poole.

DCCG list the up-front modernisation investment but have nothing to say – you conceal from the public – the detrimental consequences of long term systemic decimation of half of our accessible medical services in Dorset. Hit worst of all Poole and the Purbecks, and mums to be in maternity emergency from most of the County.

And that all added up Mr Goodson is deception which I for one deplore.

Yes to modernisation and excellence of service which DCCG promotes. Yes of course we want full suite services with surgeons and consultants – but what value this when we end with the large sections of the population up to 30 or 40 miles away from a one and only major centre on the far edge of the County? We end with pregnant women in crisis having to travel from South and West Dorset all the way to RBH – the other side of Bournemouth. That is truly shocking, let alone emergency cases ending up two hours away from emergency treatment (ambulance time to get to Swanage and back to RBH)

National Studies – Sheffield University Research : You cite in your justification to degrade Poole A&E in our town to an urgent care unit unspecified “national studies”.

So let’s spell this out Mr Goodson. DCCG are referring to research at the University of Sheffield. That is research looking at towns a fraction of the size of our conurbation. The smallest town Bishop Auckland with 16,000 population. All the five towns in the study downgraded from A&E to urgent care add up to 150,000 less than a third of the population of our conurbation of 460,000.

Sheffield research over four years in full context gives no evidence or justification whatsoever to closing down a major A&E unit in a conurbation of our size. The research makes clear time and again results over the four years of the study were “indeterminate and inconclusive”.

“No statistically reliable evidence to suggest a change in the number of deaths following an ED closure in any site or on average across all sites.”

That is not a positive statement of endorsement to close down a major A&E unit for a major conurbation. Researchers had “no reliable evidence”. The Professor leading the research Professor Jon Nicholl concluding : “It is important to highlight that we didn’�t find the better outcomes for patients that planners hoped to see from closing these small departments. It isn’�t clear that the disruption and anxiety that can be caused by closing emergency departments is worthwhile.”

It is then outrageous Mr Goodson that DCCG tell the people of Dorset there is going to be “minimal impact”. And even more outrageous to claim “60 lives will be saved from changes” when you have not a scrap of evidence to show that degrading A&E to urgent care will be of benefit. On the contrary the Sheffield study came to no conclusion let alone a positive conclusion. And more than this we have the whole issue of ambulance time responses.

South West Ambulance (SWASFT) response times : People are going to suffer and die in their hundreds with close down of Poole A&E and maternity (equally urgent response needed) with one A&E on the far eastern side of our county.

That will happen Mr Goodson. On SWASFT’s own data modelling from A&E records 2017 DCCG cite 696 adults with ‘NEWS’ (severity) scores of 7 or more, facing longer journeys serious to access A&E. From which 150 “randomised samples” are selected as there was “not time to review all 696 in the time frame of the report”. SWASFT found 27 of the 150 cases were at risk.

27 out of 150 = 18%, when this is scaled up for the sample of 696 adults at potential risk, we have 125 adults at risk. The Ambulance Trust Report also found 3 mums-to-be at risk – although as 80% of mums to be facing maternity emergency don’t come by ambulance, multiplying this by 5 would be more accurate. And 4 children at risk – again the vast majority of child emergencies don’t arrive by ambulance. So at the very least 125 adults, 3 mums to be and 4 children – that’s 132 at risk – and the Ambulance Trust Report only covered a 4 month period. So 132 over 4 months is at least 396 at risk of harm, and that’s each year.

Harm including irreversible medical damage, and fatality. Looking at the state some of the cases are in – an unresponsive child facing a 9 minute longer journey, and a child ‘post cardiac arrest’ with a 4 minute longer journey if Poole Paediatrics was not there, a mum-to-be with ectopic pregnancy bleeding into abdominal cavity with 10/10 pain and life threateningly low blood pressure, facing a 19 minute longer journey if Poole Maternity was not there, many adults with sepsis whose access to antibiotics would have been delayed for up to 23 minutes if Poole A&E was not there, a 33 year old knocked over by a car facing a 14 minute longer journey if Poole Regional Trauma Unit was not there.

These patients are in imminent danger of dying and indeed SWAST have themselves provided a ‘Potential Harm’ column for the adult cases in which they have written ‘Yes’ against 10 of the 27 adult cases. There is no question that these patients are at higher risk of death – because of longer journeys.

On common sense we can’t go down to one A&E with travel distance from Purbecks and Poole increased by at least eight miles with ever increasing gridlock congestion and not expect to have considerably increased travel time risks. But DCCG have nothing to say on this. Not a word in your propaganda sheets on increased travel time risks. And take note Bournemouth and Poole rated nationally as one of the most congested conurbations in the country. Every reason to have more than one A&E and more than one Maternity unit. A matter of sharing load not congesting into one centre with no backup units in another hospital.

A338 gridlock – strong possibility Wessex Fields development and link road will not be permitted:

I trust DCCG planners have read the Environment Agency catalogue of multiple objections to the A338 spur road and Wessex Fields development plans. Proposals to layer millions of tons of concrete on dozens of acres of fields on of all places a drainage flood plain.

And that is the Stour river flood plain. The flood plain that floods every year with flood water coming within 100s of yards of RBH and this is with, on the account of the Environment Agency, and World Science International Panel on Climate Change, rising sea and river levels, increasing climate instability with flash flooding, and DCCG want to locate our one Trauma A&E and Urgent Maternity unit in this hugely high risk area.

And as part of this massive relocation DCCG have made the assumption, and are pressing ahead with changes on the assumption, that the Wessex Fields development will go ahead, which in turn will unlock
government funding for a relief link road, but then taking account of the Environment Agency objections, and hundreds of objections from the public including MP Tobias Elwood, is increasingly unlikely to be given approval. The plan is also based on the expansion of RBH – might this not also compromise the flood plain and be objected to by the Environment Agency?

And in all this we have the endless gridlock on the A338 – the one and only major highway for access to RBH hospital. Gridlock caused by any major accident or road works all of which ambulances will have to contend with travelling from all over the County trying to get to our one Major Emergency Hospital and Specialist intensive and high dependency newborn Maternity. And all this with a hugely expanding population, with even more loading on the NHS.

In all Mr Goodson I unreservedly deplore and condemn DCCG one sided propaganda wrapped round the Poole Herald.

Give a balanced account and that will in my view be far more respected. Tell the people of Dorset the funding has been inadequate for the past 8 years driving DCCG into deficit. DCCG do signal this with the phrase “financial contraints” but then promote selective improvements out of all context of decimation of budgets. We know this is rolling down from NHS England. And those who look into these matters will know this is driven by bond and money markets.

Market economies can’t make direct profits out of health – or education or policing or any other public services. And so it is market capital gravitates to high profit markets (banking, derivatives, gaming, alcohol, etc) with then governments that are welded to market economies trying to construe pseudo market economy within our health service which brings us to the horrendous state we are now in. Huge waiting lists hospitals with huge backlogs of maintenance.

So tell the people the truth Mr Goodson. Explain the Dorset budget is at least £158 million short, every year, of what it needs to be. On Treasury budgets we cannot any longer afford a comprehensive health service with full services in all hospitals. DCCG have been forced to resort to centralised units and bad luck on all those who live remote from the centralised unit.

And also and critically NHS needs to ungag medical staff working in our NHS. It’s a sure sign we are moving into totalitarianism, if not worse, when people – the best of our people – our doctors and nurses and all support staff who commit their lives to caring for others – are gagged and can’t speak out on critical public issues.

I for one will not stand by and see our NHS decimated and all the worse enormous cuts in services dressed up in propaganda wrapped around a newspaper.

Next week I will be chaining myself in protest on hunger strike to Poole Hospital railings. The least I can do in huge respect of Nye Bevan the founder of the NHS and all he suffered and in highest respect to our medical staff. We cannot stand by with such hard working people being chronically undermined by government Ministers welded to money markets shockingly cutting budgets and pressing NHS managers to package it all up as modernisation and improvement.

Bloated banking – trillions in “quantatitive easting” – our health service starves.

Response by Chief Executive Tim Goodson

Dear Mr Williams,

I appreciate that you are clearly concerned about the changes but I believe a number of your concerns have been based on misinformation that is being pushed around in the media at present. I hope that the following information will help to reassure you.  If you would like to talk to someone from the CCG or Poole Hospital face-to-face to discuss this further, I would be very happy to arrange this for you. 

You make many points and I will address as many as I can.

Firstly, I would like to point out that the plans to improve access to the Royal Bournemouth Hospital via a link road predate our Clinical Services Review (CSR) decisions and improved access to the area would be required regardless of whether we had carried out the CSR or not.

I’m sure you will be aware that the CSR was carried out over a period of three years before the CCG’s Governing Body – predominantly made up of medical doctors – took their considered decisions.  The CSR was clinically-led, involving hundreds of doctors and health professional from all NHS organisations across Dorset.  This was to ensure that the plans were evidence based and in the best interests of patients for now and the future.

We carried out considerable public engagement, a formal consultation and worked closely with elected representatives to ensure that local views were heard.

Despite this, there seems to be some misunderstanding about what the plans will mean in practice.

For example, it is somewhat misleading to say that Poole Hospital’s A and E is closing.  It is much more accurate to say that Poole Hospital’s A and E is changing. There will be a 24/7 urgent treatment centre on the site, we are currently planning for this centre to have the capacity to see approximately 53,000 patients per year.  That is around 80% of the current Poole A and E capacity. This number may even increase as we look at a different mix of procedures (operations and other treatment) being undertaken in the centre as part of new ways of providing care. Therefore the majority of people who go to Poole Hospital now will keep going to Poole Hospital in the future.

By consolidating specialist A and E consultants at the Royal Bournemouth Hospital, we will be able to provide on-site consultant-led care 24/7 which we cannot provide currently at any of our A and E facilities in Dorset.  This will benefit 33,000 people who currently arrive at Poole and Bournemouth’s A and E departments when there is no on site A and E consultant.  We will also significantly reduce the number of patients who have to be transferred from one hospital to the other because they will go directly to the specialist emergency hospital. 

Poole Hospital will remain a very busy and vibrant major hospital treating patients for a range of planned care.  It is important to note that most people will require more planned care in their lives than emergency treatment and Poole Hospital is well served by bus and train links to support such pre-arranged planned appointments for procedures.  

In regards to your concerns over the proposals adding to congestion, I would like to point out that we estimate the number of procedures that will move from one hospital to the other hospital will be of an equal number, that is, 42,000 each year. So the number of people travelling to either hospital will be broadly the same as it is now. It’s just that people will be going in the opposite direction compared to their current trip, so it effectively cancels itself out and therefore does not add to the current congestion. In terms of the numbers of procedures swapping sites over the entire year, if each one represented a single car journey this would be is similar in volume to that going round a busy roundabout in Poole/Bournemouth every single day – about 30,000 to 50,000.  Which in itself is very small compared to the influx of people driving into the conurbation each day.  Therefore the impact on congestion by our proposals even if we take the entire years’ worth, is negligible compared to just the current daily traffic volume.

In relation to your comments on finances, I do not recognise any of your figures, be it savings of £180m or total budget £800m and certainly not the netting of the two off to arrive at £620m. The assumption that the savings are in fact cuts to the total budget is completely wrong. I can assure you that we are not cutting the total spend in Dorset on health services.  Any savings that we can make are just a subset of an overall increase in total spending on the NHS in Dorset.  This has always been the case as the NHS budget in Dorset has increased each year and based on the latest Chancellors budget will continue to do so for the foreseeable future.

It is certainly not accurate to state that we no longer have a National Health Service in this country. Nationally, the NHS deals with 1 million patients every 36 hours and care remains free at the point of delivery. To suggest otherwise would be a great disservice to the 1.2 million dedicated staff who work for the NHS as well as the millions of people who benefit from the full range of services from primary care through to highly specialised, life-saving surgery.

I hope that the above has helped your understanding of some of the issues and please do contact me if you would like me to arrange for you to talk to someone about this further.