If we lose the services at Poole hospital we will know who is exactly to blame.
‘Dorset CCG claim, including in the Echo last week, that their plans will bring a range of benefits to residents.
I’m writing in response to these claims, to put the facts before the public.
1) There is no clinical evidence that the plans will support healthier lives. There is no evidence base to support reduction of A&E and Maternity locations in a rural area like Dorset, however there is clear evidence of increasing fatality with distance to care, and no proper risk assessment of the plans has been carried out.
DCCG calculated for the High Court that 132 ambulance emergencies over 4 months, or 396 per year, would be put at ‘potential clinical risk’ due to longer journey time under the plans. This does not include the risk to the vast majority of maternity and child emergencies, who self present to hospital. Dorset CCG state in their Equality Impact Assessment that longer travel in labour, birth and child emergency is a significant risk.
2) State of the art facilities. What we need is more staff and more beds. New buildings do not solve these issues and the Trusts will have to repay £5 million per annum in ‘dividends’ for the Govt’s £147 million ‘investment’.
3) The ‘integrated community services’ on which the cuts to A&E and Maternity departments and acute beds are predicated, will be funded out of a revenue deficit – none of the £147 million is for these services – and DCCG calculated a staff shortfall of approx. 900 staff for these services in 2017. There is in any case no clinical evidence that integrated community services, however welcome, can reduce demand for acute services and beds below baseline.
4) Many staff do not in fact support these changes, they believe the changes are dangerous, and staff, including senior staff, gave this feedback to the CCG during the consultation process, but it was ignored. It is an indictment that staff who do not support the plans do not feel safe to speak out publicly.
5) The plans are currently being reviewed by the Independent Reconfiguration Panel, following referral from Dorset County Council, supported by 8 other Dorset Councils (Poole Borough, Weymouth and Portland Borough, Purbeck District, Swanage Town, Portland Town, Langton Parish, Corfe Parish and Worth Parish) due to concerns about i) risk to life due to longer travel to access care in emergency and ii) that community hospitals and beds were being closed but there were no replacement ‘integrated community services’. The plans are also in breach of at least three of the five tests for reconfiguration:
a. they reduce patient choice: downgrading Poole A&E, closing Poole Maternity, and closing Community Hospital beds in 5 of 13 Dorset locations means that patients have less choice in terms of the location they will be treated in and care will be moved further from home.
b. there is no clear, clinical evidence base: although there is evidence that the closer services are to home, the more likely they are to be accessed, and to be accessed sooner, supporting prevention and improving outcomes, given the funding and staffing shortfall for integrated community services, the only plans that are being, or have any prospect of being, implemented in the foreseeable future, simply involve the closure of local Community Hospitals and beds, and the reduction of acute services and beds.There is no evidence that integrated community services, were they in place, would be able to reduce the need for acute care below the current baseline, and therefore, there is currently no evidence base for reducing acute services and closing acute beds. There is no evidence base for centralisation of A&E, Maternity and Paediatric services in rural areas where longer travel times outweigh any benefits of ‘better’ care on arrival. Indeed there is evidence from Shropshire, a rural county similar to Dorset, of worse mortality outcomes following centralisation of stroke services.
c. The plans fail the ‘beds’ test: Dorset acute and Community Hospital beds are being closed, before any replacement staffed services are in place, in contravention of the beds test. So far 74 (to our knowledge) much needed and valued local step up and step down beds, offering rehabilitation and palliative care, and easing pressure on acute beds, have been closed. We are not aware of any replacement services designed to reduce the need for the community beds that have closed. In the case of Portland and Ferndown bed closures, DCCG has argued that the beds have been replaced with beds elsewhere – Portland beds at Westhaven and Ferndown beds at RBH – these are not close to home, transport links are poor, and in the case of RBH they are not ‘community’ beds at all – how is this ‘integrated care close to home’? In the case of the Wareham (16) and Bridport (20) community hospital bed closures, there are no claims of any replacement beds elsewhere.
Acute beds: we have 1,810 acute beds, DCCG forecast need is for 2,467 beds yet DCCG plan to close 245 of the acute beds that we have now.
d. Strong patient and public engagement: DCCG will say there was public and patient engagement, however the public feel misled and ignored. The proposals were unclear and had closures built in, there were glaring omissions (eg neither Poole Maternity nor the loss of 2/3 of Poole Hospital beds was mentioned) and promises were made that the CCG later denied in Court – such as for 24/7 Consultant delivered A&E care.
36,910 people signed petitions to save A&E and Maternity at Poole, but these signatures were put in ‘qualitative themes’ rather than ‘quantitative data’ – they were, literally, discounted. Opinion Research Services Interim Report shows that a total of 10,624 respondents answered the questionnaire on the issue of emergency hospital services, less than 1/3 of those who signed petitions opposing the CCG’s proposal.
The CCG favoured option B, one emergency hospital in the East sited at Bournemouth, however in every pie chart those opposing this – those choosing option A + those choosing another option, are always greater.
6) The 24/7 Consultant delivered care claim was denied by the CCG in the High Court. Currently Poole and RBH each have 1 Registrar overnight (not a Consultant): from 9pm at Poole and from midnight at RBH. This means there are currently no Consultants on site overnight in Dorset – they are on call. No new Consultants being recruited have it in their job descriptions to work overnight. There are no plans to provide 24/7 consultant delivered care in the foreseeable future, and this claim is highly misleading.
7) The plans will lead to MORE transfers between the hospitals because people will self present to the UCC who need A&E care or admission, and who will have to be transferred to RBH. There were almost 40,000 unplanned admissions at Poole last year, 91% of Poole’s admissions were A&E admissions. Many of these patients self present, and none will be able to be treated at the proposed Poole UCC. Also planned operations patients, and outpatients, including oncology outpatients, who deteriorate at Poole and need a higher level of care would also have to be transferred to RBH.
8) Outcomes will worsen for cardiac patients as the plans essentially involve closing Poole cardiac department, which treats some types of heart attacks. A FOI shows that in 2017 127 heart attacks were treated at Poole, 102 of which were taken there by ambulance, and 38 cardiac arrests were treated at Poole, all taken there by ambulance, in fact more cardiac arrests than the 30 that were taken to RBH that year. The Ambulance Trust’s triage tool tells them to take patients to the nearest A&E where there is danger of loss of life. What will happen to these patients when Poole A&E is no longer there?
9) Outcomes are likely to worsen for stroke patients as there is no clinical evidence base for centralisation in rural areas where longer times to care outweighs any benefits. Since the centralisation of stroke services in Shropshire, a rural area like Dorset outcomes have worsened and Shropshire has some of the worst stroke mortality rates nationally. This is mainly because the vast majority of patients arriving at hospital and having essential pre treatment tests are then out of time for treatment with clot busting drugs.
10) Given that 245 acute beds will close, and the reduction in beds at Poole from 654 to 247, it is extremely unlikely that it will be quicker to access a bed for a planned operation than it is at present. The only way to avoid operations being cancelled due to planned beds going to A&E patients is to deny access to beds for A&E patients in urgent need of care. This is unacceptable.
11) It is not clear on what basis shorter waits for cardiac treatment and reduced length of stay can be related to any hospital location. It is difficult to see how the same number of staff with more patients and less beds will provide a better service. Putting all the staff on one site does not increase the number of patients any single staff member can deal with safely.
12) The claims for ‘new’ services at RBH are again highly misleading and these services are simply those closing at Poole. The ‘new’ Urgent Care Centre is a downgrade from Poole A&E. A UCC treats a narrow range of health issues, the same as those treated by a Minor Injuries Unit*, and can be Nurse led.
*minor injuries: sprains and strains, broken bones, wound infections, minor burns and scalds, minor injuries to the head and torso, insect and animal bites.
Chris Bradey
East Stoke
Defend Dorset NHS
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