Defend Dorset NHS
The Rt Hon Matt Hancock MP
Secretary of State for Health and Social Care
39 Victoria Street
London SW1H 0EU
Your Ref: TO – 1156976 11th January 2018
Dear Secretary of State
Re: Dorset County Council’s referral of Dorset Clinical Commissioning Group’s Hospital reconfiguration plans, now supported by Poole Borough Council.
Thank you for the letter that our Residents Group has received, dated 3rd January, and written on your behalf by Christian Brinsden.
Thank you also for Mr Brinsden’s reassurance that you are considering asking the Independent Reconfiguration Panel to review Dorset CCG’s plans, in which case all correspondence from our residents group will be forwarded to the panel for consideration as part of their independent review.
There have been some developments since I wrote to you on 8th December.
On 17th December Poole Borough Council Health Scrutiny Committee voted unanimously to support Dorset County Council’s referral. They repeat Dorset County Council’s concerns about risk to life if the planned closure of Poole Regional Trauma Unit and Specialist Neo Natal Consultant Led Maternity and Paediatric Units goes ahead. I am sure you will have received Poole Borough Council’s letter, and I enclose a copy here for ease of reference.
Please be aware that, should the plans go ahead, the catchment population for the one A&E, Maternity and Paediatric service at Bournemouth Hospital will be approaching half a million people, some of whom will have a blue light journey of an hour to get to the Hospital, once the Ambulance has arrived.
A previous Freedom of Information Act request submitted to you (1) showed that for some areas, the average time now, while emergency services at Poole are open, between a category 1, imminent danger of death call to the Ambulance Trust, and arrival at Poole Hospital, is 1 hour 43 minutes.
On 13th December Dorset CCG published an ‘Expert Review’ (2) which claimed that none of the 34 critically ill patients listed in the South West Ambulance Trust Report of August 2017 (3) would have suffered any ill consequences if A&E, Maternity and Paediatric services had not been available at Poole, and they had had to travel further to get to Hospital.
However, from reading the Review, and following disclosures at Poole Health Scrutiny on 17th December, it seems that some of the patients in the Report died anyway, and that for some of the other patients, the Ambulance Trust data used to select at risk cases was incorrect. For example, the mum to be with ectopic pregnancy and extremely low blood pressure due to suspected internal haemorrhage did not have a haemorrhage and the low blood pressure was ‘not pregnancy related’. The 90 year old overdose with ‘difficult airways management’ did not in fact have any airways problems. The ‘child post cardiac arrest’ had not, in fact, had a cardiac arrest, and so on.
In a nutshell a minimal risk assessment has been carried out on a small number of Ambulance patients, and closer inspection has revealed that the patients reviewed are not those most affected by the planned reconfiguration.
This supports our key concern that no proper risk assessment has been carried out on the risk to Dorset lives of the planned Hospital reconfiguration.
The issues with the very limited risk assessment that has been carried out through the South West Ambulance Trust Report include that:
1. The majority of Maternity (4) and Paediatric (5) emergencies were excluded from the Report as they do not arrive at Hospital by Ambulance. Yet Dorset CCG acknowledge that longer travel time for maternity cases and for paediatric emergencies is a ‘significant risk’ (6). Under the plans the sole Dorset Maternity service for mums giving birth under 32 weeks, and the sole newborn intensive and high dependency care service, would be out of safe reach from most of Dorset. They would be located in the far east of the County, beyond the safe guideline travel times of 30-45 minutes (7).
2. A significant minority of adult time critical emergencies did not arrive by Ambulance either, so they were also excluded from the Ambulance Trust Report (8)
3. The methodology used in the Ambulance Trust Report to identify potential at risk Ambulance patients is open to question. For Adult cases, measures used to reduce the sample facing longer journeys included a severity level (NEWS score of 7) far beyond that used in A&E (NEWS score of 4) and then a ‘data cleansing’ process was applied that removed almost 60% of the sample remaining after the very high severity measure of a NEWS score of 7 had been used.
Only 20% of the 696 cases that then remained were reviewed.
4. The Ambulance Trust Report made no attempt to ensure that those who would face the longest journeys under the plans were reviewed. The ‘Expert Review’ published on 13th December 2018 revealed that the longest total journey time of any case reviewed was 36 minutes.
Yet the CCG’s own presentation to Purbeck District Councillors (9) showed that from some areas the blue light journey to Bournemouth Hospital is 57 minutes.
5. The Ambulance Trust Report made no attempt to ensure that those Ambulance cases who would face journeys outside safe guideline times were reviewed. CCG Consultants Steer Davies Gleave (10) cite recommended maximum travel times in maternity emergency, acute stroke and major trauma of 30-45 minutes.
6. The Ambulance Trust Report cases seem unrepresentative of the emergency cases treated at Poole. Despite the Report covering the period January-April 2017, no respiratory emergencies were reviewed, and despite Poole Hospital being the Regional Trauma Unit, and treating 569 trauma cases in 2017 (11), only 1 possible Trauma case was reviewed.
There were many questions about the comprehensiveness and methodology of the Ambulance Trust Report before it was revealed that the data used to select likely at risk cases was unreliable.
Reliable data for a comprehensive risk assessment is, however, readily available through the records of emergency cases treated at Poole Hospital.
Indeed Dorset A&E Drs working with the residents have identified several at risk groups that could usefully be reviewed if a serious attempt was being made to assess risk, for example:
the 590 maternity emergencies treated at Poole in 2017 (12)
the 251 newborns requiring intensive or high dependency care, and the further 195 newborns needing special care (13)
the time critical emergencies seen at Poole that cannot be treated in the Ambulance – stroke, sepsis, respiratory arrest, heart attack, types of cardiac arrest not susceptible to defibrillation, meningitis, overdose, haemorrhage in medical or trauma emergency (ambulances do not carry blood), neurological emergency, Addisonian crisis,
those with time critical emergencies who died within an hour or two of arrival at Poole Hospital
36,910 Dorset residents have signed petitions to Save Poole A&E and Maternity.
In addition to Dorset County Council’s referral to the Secretary of State, and Poole Borough Council’s support of this due to shared concern about risk to life, the following Councils ask for the plans to be independently reviewed:
Langton Parish Council, Worth Parish Council, Corfe Parish Council, Swanage Town Council, Portland Town Council, Purbeck District Council and Weymouth and Portland Borough Council.
Residents fully support concerns about the plans raised by Dorset County and Poole Borough Council. We implore the Secretary of State to ask the Independent Reconfiguration Panel to review the plans, and to ensure that a comprehensive risk assessment is carried out for those groups most at risk.
Yours sincerely
Debby Monkhouse
For residents group Defend Dorset NHS
References:
Much of this evidence has been submitted previously in the evidence folder posted to the Secretary of State by Special Delivery on 13th November 2018.
1. Evidence folder, Appendix 10, pages 1 & 2: Freedom of Information Act request from Langton Parish to South West Ambulance Trust
2. Dorset CCG “Expert Review”
3. Evidence folder, Appendix 1: South West Ambulance Trust Report
4. Evidence folder, Appendix 4: Freedom of Information Act Request to Poole Hospital – page 2 shows that 456 of the 590 maternity emergencies treated at Poole in 2017 did not arrive by Ambulance
5. Dr I Mew, Consultant in Anaesthetics and Intensive Care Medicine, “Feedback on the 31/8/17 CSR Meeting to identify potential risks to patients following the publication of the Ambulance Trust Report”:
“As paediatrics and obstetric patients in the vast majority of cases self present to hospital, the commissioned modelling does not, and must not be used to represent the impact of journey times.. for these groups”
6. Dorset CSR Equality Impact Report 2017 page 23: “Travel time for intrapartum (labour and childbirth) care and children requiring acute paediatric services is perceived as a significant risk.”
7. Evidence folder, Appendix 8: Steer Davies Gleave Travel Times Analysis, page 3
8. Evidence folder, Appendix 4: Freedom of Information Act Request to Poole Hospital – page 2 shows that 137 of the 687 adults with a specified range of time critical conditions treated at Poole in 2017 did not arrive by Ambulance
9. Evidence folder, Appendix 9: DCCG Presentation to Purbeck District Councillors 29/11/17 page 2
10. Evidence folder, Appendix 8: Steer Davies Gleave Travel Times Analysis, page 3
11. Evidence folder, Appendix 4: Trauma Audit and Research Network data on Poole Hospital showing 569 cases treated in 2019
12. Evidence folder, Appendix 4: Freedom of Information Act Request to Poole Hospital – page 2 shows that 590 maternity emergencies were treated at Poole in 2017
13. Evidence folder, Appendix 5: Freedom of Information Act Request to Poole Hospital on Newborns needing care beyond a normal delivery: – page 3 shows that 251 newborns needed intensive (80) or high dependency (171) care, and a further 195 needed special care
