Dorset Clinical Services Review : Modelling Impact
RBH – Clinical Services Review
DCCG – the need to close down services
Poole Hospital Annual Report 2017/18
NHS Targets being missed across UK : Nov 20th
Dear Mr Goodson,
Thank you for your reply 8th November regarding reorganisation of Dorset wide NHS.
You speak repeatedly of “misinformation”. I agree accuracy in context is of the highest importance.
It is then correct and accurate to state Dorset Clinical Group, on an unprecedented scale, is reorganising Dorset NHS. In this process CCG is closing down whole departments of hospitals, along with four cottage hospitals, overall the county loses 250 hospital beds. The consequence for many thousands in Poole, and west of Poole, having to travel far further distances (at least 10 miles) for emergency treatment. And that means, on all clinical research, and by common sense, more people in urgent need (including maternity cases) are going to suffer and die.
These statement are all accurate Mr Goodson. There is no misinformation. They can all be substantiated, with evidence.
As one general example, you want to refer to “changes”. You don’t want to use the word “closure”. “Changes” then is wholly inaccurate to the point of being meaningless. To say an A&E department is “changing” tells us nothing. Stating a department is “closing” tells us exactly what it happening. The department is closing down.
That said notably you are highly disparaging towards the media. All in the media is it seems wrong, inaccurate, or misinformation.You allow no possibility of accurate criticism speaking for many tens of thousands in Dorset. And at the same time notably happy to use the media to sell your programme – one sided view and one only. The vast majority of the population in Poole, Purbecks, and Dorset, horrified by the changes, DCCG transpose this to “Not everyone will agree with our decisions”. That then the understatement (misrepresentation) of the century. And you assert that we are inaccurate. This then all the reasons the whole issue needs to got to an independent panel.
Below listing of the key issues arising from DCCG plans. Any point wrong or inaccurate by all means explain. In all context people can see the NHS starved of funding before our eyes. We all know so many cases of people in distress waiting hours for ambulances, and waiting months for major treatment, NHS making clear year after year critical health targets are not being met. And now 2018 worse and worse again DCCG is taking – the target – £147 million out of Dorset operational budget every year. You call this a “subset” of an “increase”. The vast majority of the rest of the county calls it decimation of our health service – before our eyes. The listing of key issues is then :
DCCG ORS Opinion Research Services Statistical Survey : 394 page survey. Professor Richard Stafford PhD on his analysis (attached) states :
“In conclusion, the responses to the CCG consultation documentation are likely to be more negative than indicated in the table”
“The company (ORS) must also be aware they are analysing data from questions deliberately set up to contain bias and reflect the results wanted by the CCG”
“There is clearly overwhelming opposition to this closure based on survey data”
50,000 SIGN PETITION SAVE OUR A&E : Overwhelming opposition as reported in Bournemouth Echo. And this one of three petitions run in the county over the past two years. How then could it be clearer public opinion entirely in accord with the conclusion of a nationally leading expert in the field of statistical analysis.
Poole loses A&E – this moves with expansion to Bournemouth RBH. This means in Poole there will no longer be access to emergency treatment and operations for heart attack, stroke, sepsis, internal bleeding, road traffic accidents, appendicitis : any treatment needing surgeons and a theatre. I make this highest on listing as one Poole Cllr in recent weeks has said “we will still have access to emergency treatment in Poole” adding “this is what we were told”.
Poole 24/7 GP led Urgent Care Centre : You state in your reply that following closure of Poole A&E Poole UCC will have a capacity for “53,000” which is “around 80% of the current A&E capacity”. But this is not the critical point Mr Goodson. From NHS documents Poole Annual Report 2017/18 (pg 13), of 68,070 patients who visit Poole A&E each year 37,478 were admitted as A&E cases.
55% (37,478) of all visits to Poole A&E 2017 were A&E admissions and in your wording your are leading people to think that the Urgent Care Unit will deal with “80% of current visits to A&E”.
Again grossly misleading misinformation. Urgent Care capacity (53,000) is not the critical point. The critical point is that 55% of current A&E visits (not 80% as you put in bold) will be dealt with in the new Urgent Care Unit.
An enormous disruption for tens of thousands of patients. In the words of Professor Nicholl, who led the Sheffield Research which DCCG repeatedly cite as evidence base for claims downgrading A&E to UCC is beneficial: “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”.
Planned treatment and operations : Poole become the centre for planned treatment and operations. In the process although there are new theatres there is enormous downsizing in hospital size. Poole loses 400 beds.
And we lose from Poole our Maternity Unit : As with A&E this is an urgent access unit. Last year 4,500 babies were born in Poole. When changes take place mothers along with all A&E patients will have to get out to RBH the other side of Bournemouth. Bad luck if you don’t have a car. Bad luck if it’s a foggy evening. Bad luck if the A338 is blocked by an accident or road works.
Access to RBH : We all know it is shocking. Dreadful. The A338 forever gridlocked from accidents or road works. DCCG in their analysis for ambulance blue-light times use “proxy” night time response times. One of the many slights of hands in DCCG desk-top modelling. As if blue light ambulances during the day with heavy traffic congestion can travel the roads at the speed of an ambulance at night with empty roads.
The RBH link road : you comment that the link road would be required irrespective of whether the A&E move goes ahead. But the point Mr Goodson you (DCCG) and RBH Chief Executive are selling the link road (all in the DCCG documents) to the public as a large positive in alleviating traffic congestion. RBH states categorically : “There is also a new highway infrastructure for which Bournemouth Borough Council already has funding linking the hospital directly to the Wessex Way” :
On this count alone DCCG/RBH are grossly misleading the public. There is no certainty on this issue to be stated as a fact. Opposition to the link road from the Environment Agency alone is considerable. There is a strong possibility the road will never be approved. And even if approved we have then with Wessex Fields development even more congestion. This aspect of DCCG plans one of so many grossly misleading statements from DCCG.
Access to Poole hospital : Could not be better. Several suburban access roads with a dozen buses passing the hospital every hour from all over the conurbation. But to RBH – one bus an hour from Poole and that taking an hour and a half. DCCG have given no consideration to public transport access to RBH.
Ambulance one-way analysis : In CCG SWAST analysis ambulance response times are given for the one way journey back to RBH alone. No account is taken for the time for the ambulance to travel from RBH (or wherever stationed) to the incident. One more of so many glaring anomalies in DCCG modelling. To understand response times we have then to double the times given in DCCG SWAST statements. Thus an incident in Swanage, with the need for an ambulance to travel from RBH to Swanage and back to RBH, on a clear road will at best be 1 hr 40 minutes.
In analysis and modelling DCCS takes no account of self admissions : Tens of thousands of people every year, including and in particular thousands of maternity cases, self-admit to A&E and maternity. They come in by their own transport. In modelling DCCG takes no account of these admissions. A small sample of A&E ambulance cases (27) is analysed; self-admission cases for DCCG do not exist. If they were considered they would show up the horror of many more thousands who will have to travel all weathers day and night from Poole and Purbecks to the far side of Bournemouth.
Either Or Choice : We have been led into an invented either or choice. A&E and maternity at Poole, or at RBH. But then this invented choice, in itself a huge distraction, forced on the county by the enormous cuts. We should be developing all our major hospitals for full A&E, Urgent Care Units, and full neonatal maternity. What we should have in a modern progressive country. Improving and expanding services not in the face of rising population contracting down to half of what we need.
Availability of Consultants : I find your statement in your reply 11th November on the matter of consultants extraordinary : “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”. So we are saying NHS is so enormously underfunded we can’t afford 24/7 consultant cover at all our major hospitals. That then for me Mr Goodson is the insight of insights telling us on any international standard our NHS is indeed collapsing before our eyes.
Tell us NHS services are being massively cut Mr Goodson, on the back of huge cuts in budgets, you will then be telling the public the truth. Instead of selling draconian cuts to the public as “changes” which “not everyone supports” you might like to report back to NHS England and DHSS the people of Dorset bitterly oppose this mass close-down of whole departments of our NHS.
On all these counts we condemn without reservation the shockingly misleading information being used to cover this mass close-down of services : Fraud Act 2006 – Fraud by False Representations – “dishonestly making a false representation … to cause loss to another or to expose another to a risk of loss”. I cannot think of a more total loss than loss of life through delays in access to an accessible A&E department. 20 miles Swanage to Poole acceptable, 31 miles to RBH a huge difference in accessibility.
Budgets – driving all the contractions : DCCG makes clear time and again budgets have to cut back by £147 million a year (£157 million by 2023). This then is happening. And the fact is NHS is an enormous budget : £120 billion – 30% of national public service costs. This needs dealing with but then the manipulation of information, DCCG directing people to focus on improvements and in that distracting away from the close down of whole departments.
Budgets – bottom line : £147 million a year is being moved from operational costs to capital investment. That is how it works and that is why Tim Goodson can state “I can assure you that we are not cutting the total spend in Dorset on health services”. But what he doesn’t say is there are huge cuts (£147 million a year) in operational costs. Thus we see our NHS being decimated before our eyes. Further references :
Chair of DCCG Dr Forbes Watson – What is driving CCG to make these “enormous cuts”* ? : “The money we have to secure healthcare for local people isn’t increasing at the same rate as rising costs and demand”. NB * “changes” changed to “enormous cuts” to make the issue clear. As said “changes” is highly ambiguous, conveys no meaning.
The Kings Fund : “The Department of Health budget will grow by 1.2% in real terms between 2009/10 and 2020/21. This is far below the long-term average increases in health spending of approximately 4% a year above inflation (giving 6.2%) since the NHS was established”. These rises to match rise in population with large rises in numbers of elderly patients.
The future of healthcare in Dorset : the need to cut services* : “By 2012 we will face a funding gap of around £158 million – if we don’t cut back on services”. (* Again I’ve translated “change” to “cut” to convey clearly what is happening).
Our vision for the future : Again considerable emphasis with charts on the “funding gap” (translation : “underfunding of NHS for years”). Notably you give no total Dorset NHS budget figures.
10 charts that show why the NHS is in trouble : Total NHS budget £120 billion (£120,000 million). In England we have 196 CCGs. This works out at around £750 million per CCG. The figure along with the cuts you say you don’t recognise. But then you don’t tell the public the total budget and so if wrong by all means correct. We have currently a £147 million short-fall out of what total ? Dorset NHS budget is ?
“We will have better services nearer to people” – the promotion from DCCG : With claims that impacts will be “minimal” and “60 lives a year will be saved”. This then classic marketing promotion when the truth is through DCCG planned centralisation hundreds of people will suffer and will die. This is evidenced in every report and in the view of every clinician who has ever spoken on the issue. Longer journeys in life-threatening cases inevitably lead to higher risks of mortality. A matter of fact in every ambulance response time report ever written.
And beggaring all belief (star prize for staggering all credibility) with A&E and maternity moving ten miles away from Poole (31 miles from Swanage) DCCG have the brazen audacity to claim we will have “care closer to home”. And this is not highly misleading misinformation Mr Goodson ?
Clinician participation in DCCG decisions : The Chief Executive tells us the governing body is made up “predominantly of clinicians”. But Mr Goodson all in the group have been forced to work within the budget handed down from NHS England and DHSS. No-one doubts clinicians are not doing the best they can. The issue is the enormous budget cuts and all the worse by stealth. The NHS starved of funding. Clearly the government solution centralisation of service with an end for many thousands to local access.
“What do staff in Dorset think of the proposed enormous cuts (changes) ?” : DCCG quote : “Clinical staff across all of the hospitals in Dorset and colleagues in Primary Care agree that the current pattern of hospital provision needs to be strengthened and is not sustainable in its current form”. Again from DCCG another nebulous double negative statement. It does not remotely affirm that staff agree with close down of Poole A&E, maternity, and four community hospitals. All it tells us is that staff agree current situation is unsustainable. And that of course points time and time again to unsustainable underfunding.
NHS Non-disclosure clauses : Also highly relevant NHS staff sign non-disclosure contracts. And if not the last thing the vast majority of clinical staff will want to do is upset their employers speaking against NHS policy. For all these reasons I take the view all of us trying to put a stop to these enormously damaging cuts are speaking up where clinical staff cannot speak up.
10% of all 999 ambulance calls are life threatening – but not in Dorset : Look through all the national ambulance reports and we see that as a national statistic 10% of 999 call out are life-threatening needing hospital access. This is stated for instance in the University of Sheffield research. But not in Dorset. In the DCCG modelling report they tell us 1% of 999 call outs are life threatening. One tenth of the rest of the country. Quite astounding but then one of dozens of “anomalies” you will find in DCCG sales brochures.
Deaths and mortality – DCCG “What if” Data Modelling : DCCG take 1,600 ambulance cases from 2017, taking down to 696 serious cases, from which 150 “randomised samples are taken” as their is “not time” to analyse all 696. Then finally cut down to 27 cases given full analysis. Study these documents, and national figures, and it could not be clearer with longer journey times many hundreds are going to suffer and hundreds are going to die.
National Studies – Sheffield University Research – this research is quoted many times (vaguely – never specifically) by DCCG as the evidence base to support downgrading A&E to Urgent Care. But then look at the report and you will see there is no evidence whatsoever to support taking Poole A&E down to an Urgent Care Unit.
What DCCG took from the Sheffield research was again a “double negative” and turned it into a positive. One of dozens of misrepresentations DCCG use in their documents. To quote from Sheffield : “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.” The research was entirely ambiguous with huge numbers of variables and this in towns of 19,000 population far removed from Poole Bournemouth conurbation of 460,000.
What Professor Jon Nicholl leading the research did say in conclusion : “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.” No grounds whatsoever to support closing an A&E department.
On the contrary all the reasons to keep and develop two full trauma A&E departments in our conurbation of 460,000 – in accord with the Keogh Report 2014 driving these changes, stating : “The number of Emergency and Major Emergency Centres should broadly equal the number of current A&E departments”.
Integrated Community Services – from hospitals to Community Hubs : Dorset has 13 community hospitals. They are being rebranded community hubs. Three are being or have been closed down : Poole Alderney, Ferndown St Leonards, and Portland. Three are losing all their beds : Westhaven Weymouth, Wareham, and Christchurch. What are left are rebranded Community Hubs. There are no new medical staff. Nothing more is added. Simply rebranding and in that distracting from six out of 14 either closing down or losing beds.
Dorset Integrated Urgent Care System : This is to be a “Single Point of Access (SPOA) system. Which means all access to urgent care will be through a 111 call centre using interactive voice recognition systems. You call 111, work your way through a menu, and then when you do reach an adviser (typically three weeks medical training) they work through a computer lead series of flow diagram questions to determine where next to refer you. This is for Urgent care 24/7 but will be expanding for access to GP surgeries.
Local Surgeries Closing Down : And yes Mr Goodson they use the word you won’t use – the dreaded “closure”. Perhaps then from an analyst’s point of you avoiding this word (as also death, mortality, fatality, in DCCG SWAST reports) is the shield used by those involved in these mass closures to avoid facing the truth of what is happening. And that is decimation of our emergency and maternity services in Poole. This doesn’t all fall on your shoulders, or that of the DCCG, but we can all make a stand on what we think is right.
To quote Cllr Karen Rampton in Poole : step up to the plate. Tell the world we need and demand a fully funded progressive National Health Service. Not end up with officials selling us a package of mass closures as “changes” which will give us services “closer to home”.
In any case the point here we are losing surgeries by the month : And worse again land and assets are being sold off to the private sector. In Upper Parkstone we have lost one of our two main surgeries. This is typical for all towns. The one that has closed is being sold off. And worse our car-park for our one remaining hugely overloaded 20,000 patient surgery has been sold off for flats.
We thought this was the action of the land owner YTS Malaysia. But not at all. This is government policy. The commitment to sell off any and all NHS land and property that by government CCG policy is closed down. And in that the reasons why the planning application sailed through Poole Planning with no objections from Poole Conservative cabinet running Poole council. When then Poole maternity is closed down the property will be sold off. There will be no going back.
Maintenance of hospitals – crumbling hospitals : huge and mounting backlog of hospital maintenance growing over the past five years. Tens of millions of backlog in maintenance evidencing time and again the enormous underfunding of NHS. And now budgets in Dorset to be cut by a further £147 million.
Our NHS is being decimated. We should have no doubt about this. 2018 Dr Beeching Rail Network Sell-Off II (1960s closing down and selling off a third of British Rail network). There is going to be £147 million capital investment. But the price of this is huge reduction in operation budgets (matching sum) £147 million a year for all the years to come. Up-front capital investment at the cost of huge reduction in operational budgets with close down of hospital departments, community hospitals, and local surgeries. And DCCG wants to tell us this is all to our good.
And in all this in Poole we have the Conservative Newell-Gupta factor – the Cllrs who voted with all Cllrs in Poole July 2017 to support residents overwhelming opposition to these closures. They voted to support opposition then six months later (Dec 2017) in the key Joint council vote, to refer changes to the Secretary of State, they abstained – and in that setback any referral by a year.
And since – 13th November council meeting – instead of Poole council as a matter of urgency voting on and fast-tracking referral to the Secretary of State (in support of Dorset’s decision to refer) Conservative group has directed the motion to act to a scrutiny committee. Cllr Karen Rampton (PFH for Health) advising “concrete evidence” is needed. This A&E issue raging for two years and a Cllr tells us they still cannot make a decision. Again from Poole council beggaring all credible belief : let’s spin this out for months more : don’t ask us to make a decision.
The “undeclared” government led stealth policy could not be clearer – the Conservative Party in Poole unreservedly supporting closure of A&E and maternity in our town and we are all to take the consequences.
It may be the scrutiny committee will vote to refer. If so then the motion will have to be on the committee agenda for 10th December or an extraordinary meeting needs to be convened. In either case this will be a committee run by the same Cllr Jane Newell who abstained at the Joint committee meeting December a year ago. Perhaps now Cllr Newell has had more to time to look into issue and take note of the enormity of the consequences of DCCG plans.
And as ever in all this jumping through council hoops. What is essentially if not exclusively a national health issue ends up in multiple countywide councils, all consequence of a government welded hook line and sinker to markets. NHS – along with police, schools, care services, councils, probation service, youth services – all cast down and out to fend for themselves. What an awful debt driven destructive age we live in …
DCCH NHS The Vision – all the benefits : And there is no cost to pay Mr Goodson ? No downside ? What you produce here classic marketing sales brochure. By all means include this email on your website – give people an opportunity to take note of all we are losing.
Mr Goodson – you speak repeatedly of misinformation …
Council meeting 13th Nov – explaining the issues ….
Yours sincerely,
Jeff Williams CGFTC BA PGCE
Resident
Poole …
