Poole Hospital: Dear Cllr d’Orton Gibson

Dear Cllr d’Orton Gibson

Thank you for your email.

There is no robust research evidence to support the claim that distance does not matter. If you believe that there is any Dorset relevant robust research evidence, please provide it. Please note, however, that Dorset CCG was unable to provide any such evidence in Court.

To further evidence the importance of proximity of emergency services, I don’t know if you are aware that, despite Bournemouth being the cardiac centre, SWAST took more cardiac arrests to Poole than Bournemouth last year? This is because SWAST’s triage tool (page 30 of the Ambulance Report) says:

“If the Clinician believes the patients condition is such that they pose a risk of imminent cardiac arrest, they should be conveyed to the nearest Emergency Department”.

Could you clarify how many Dorset Ambulance Patients are taken straight to Southampton without being stabilised at a Dorset Hospital first?

The CCG did, however, provide clear evidence in Court of the number of patients at risk if A&E and Maternity at Poole are lost. They provided a written calculation for the Judge that 132 over 4 months – 396 per year – will be put ‘at potential risk of harm’ by the loss of Trauma A&E and Specialist Maternity at Poole. Do you dispute this?

A Dorset A&E Dr calculates that 183 of these 396 are likely to die. This is notwithstanding that the 396 at risk and the 183 likely to die do not include the risk to emergencies who are not transported by ambulance. No risk assessment whatsoever has been carried out for those patients.

As an aid, if you look at the Ambulance Trust Report*, pages 15-16, all bar one of the adult cases where SWAST has said ‘Yes’ in the potential harm column figure in the Dorset A&E Dr’s assessment of likely fatality. As I expect you appreciate, SWAST left the ‘potential harm’ column off of the tables of the paediatric and maternity cases at risk.

Here again below is the table of likely fatalities taken from the Ambulance Trust Report cases. The Dorset A&E Dr said 12 of the 27 Adult Cases, 2 of the 3 Maternity and 3 of the 4 Paediatric Cases in the Ambulance Trust Report were ‘in imminent danger of dying’ so that any longer journey was likely to prove fatal.

To calculate the actual adult ambulance patients at risk of fatality due to the plans to downgrade Poole A&E and close Poole Maternity, one needs to consider that the 27 adults listed by SWAST on pages 15-16 of their Report came from a sample pool of 150, but the actual pool of adults at risk identified by SWAST was 696 (page 15). So the likely adult fatalities of 12 out of 150, scales up to 56 likely adult fatalities out of 696. 56 adults + 2 maternity + 3 children = 61 likely fatalities over the 4 months of the Report, or 183 likely fatalities a year, of ambulance patients alone.

I note that you have not addressed the key issue, which is the 396 at potential harm, and the 183 likely to die, of ambulance patients alone. The table of the patients in the Ambulance Trust Report who were likely to die is below, for your attention. Could you clarify – are you providing medical assurances that these patients would not have died?

Likely Dorset fatalities = 183 per year of those transported by Ambulance
if Trauma A&E & Specialist Maternity Services are lost at Poole

Taken from Ambulance Trust Report (Jan-Apr 17). See Cases below:

12 Adults from the 150 sample reviewed = 56 from the 696 Adults identified as at risk
56 Adults + 2 Maternity + 3 Children = 61 over 4 months, or 183 per year
Diagnosis
Maternity Paediatric
Or Adult
Details
EExtra 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

The South West Ambulance Trust Report referred to:
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

SWAST identified Maternity Cases at risk over the 4 months on page 10, the Adult cases on pages 15-16 and the Paediatric cases are on page 24

Finally – clearly Poole was an option for the Major Emergency Hospital as the Consultation was conducted on the basis of a choice. What about the room to build up and out on the maternity site at Poole, the fact that it is more geographically accessible for the whole of Dorset, much better served by public transport, is not on the opposite side from most of the County of a gridlocked conurbation and is not built on a flood plain? I’m sure you know that several million has been invested in Poole Maternity Hospital in recent years. Regarding the helicopter: as I’m sure you know the coastguard helicopter service has been halved, the Air Ambulance is shared with other Counties, is entirely dependent on voluntary contributions so cannot be relied upon, and can carry just one patient on a stretcher. Has a a feasibility study been conducted into the possibility of landing a helicopter on Poole’s roof?

Yours sincerely

Debby Monkhouse
On behalf of residents group Defend Dorset NHS