Matt Hancock MP
Secretary of State for Health and Social Care
Dear Secretary of State,
This correspondence is to bring to your attention the enormous opposition from residents in Dorset to the planned DCCG changes.
I also take note that Bournemouth Cll David d’Orton-Gibson, on behalf of Bournemouth Health Scrutiny Panel, has written to you (22nd November) putting the case that Poole and Dorset CSR plans referral to yourself and Independent Panel is unwarranted.
What I outline below for your department is grounded in documented facts. Further down are two emails : one to Cllr d’Orton-Gibson 26th November, and below that a comprehensive statement from 21st November on DCCG planned changes and the impact of these changes.
First key point Minister we have a conurbation in Poole, Bournemouth, Christchurch, Purbecks, of 460,000 and growing. We have enormous congestion problems throughout the conurbation (in the top ten for congestion in the country), the worst on the forever gridlocked A338 which connects Bournemouth and Poole to Royal Bournemouth Hospital (RBH), and eastward into Hampshire.
DHSS Budgets : DCCG budget papers make clear £147 million a year is being moved from Dorset NHS operational budgets to capital investment budgets and also to deal with underfunding deficits (heading to £157 million 2024). DCCG plans have then been developed to fit budgets. Not supply and demand but command economy style budgets.
DCCG plan is then to close down one of our two major A&E units in our conurbation of 460,000. Whichever one is closed down there will be enormous consequences. Such a close-down has never been done before for such a huge conurbation.
It is clear that other A&E centres around the country have closed and/or been taken down to Urgent Care Centres. For instance in North-West London. But then always with a major A&E within one or two miles (which then on all public accounts become overloaded).
There are severe consequences in all such cases but for our conurbation, stretching from the Purbecks to the New Forest, we will end with an impossible situation. One trauma A&E for a catchment area of 300 square miles. The distance from Swanage to RBH 28 miles.
On all counts if this conurbation is reduced to one trauma A&E we will have massive overload of our one trauma A&E along with if located at RBH even more congestion on the overloaded A338. None-the-less DCCG and Bournemouth Cllrs (repeating what they have been told by DCC) are claiming there is national evidence to support downgrading from A&E to Urgent Care.
They are then referring to Sheffield University four years study led by Professor Jon Nicholl. This research assessed towns as small as 19,000, the largest 90,000, which had A&E downgrading to urgent care. Not a conurbation of 460,000. There is then from the report mixed and ambiguous results not least with so many complex variables.
Professor Nicholl leading the research concluded : “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 here Minister whatsoever to claim there is “research” supporting benefits of downgrading from A&E to Urgent Care. On the contrary all the reasons not to downgrade with consequences causing distress to local population with no improvements in health service.
And to keep in mind in the Keogh Report 2013 driving much of these changes Dr Keogh states : “The number of Emergency and Major Emergency Centres should broadly equal the number of current A&E departments”. There is no case in this report to close an A&E department serving a population of 180,000 – Poole and Purbecks.
The case is then here Minister a conurbation of our size will not survive loss of one of two major A&E departments. Huge overload of the one remaining A&E, with considerably increased journey times, is going to lead to even more lengthy ambulance delays, more fatalities and cases of irreversible damage. All the many thousands of cases every year where minutes mean all the difference between full recovery and lifetime disability.
In all consideration all aspect we should not be in contest between our towns, Bournemouth or Poole, as to which town has the A&E unit with expansion of units. But given that this has been forced on the towns putting then A&E along with the county’s major maternity unit at RBH has to be the worst of all possible choices.
The A338 which connects Bournemouth and Poole with RBH has notoriously horrific overload gridlock problems. There is forever road-works. Not a month goes by when lanes are not closed through major traffic accidents. And further more to compound matters even further RBH stands on Wessex Fields flood plain for the river Stour which every year floods.
The Environment Agency has made clear they do not support any more building and development on this flood plain. They point quite rightly to climate change with increasing sea/river levels along with flash flooding. But no less Bournemouth council along with DCCG are full set to see major development in the floodplain with a new major fly-over link road.
There is no way this can be spun Minister. Putting our one A&E along with our one major maternity centre for a population of 460,000 in a hospital on a flood plain with access to the hospital along the most gridlocked road in the county is going to lead to disaster. Not least already hugely overloaded ambulances trying to access the hospital.
As for opposition to DCCG plans, this could not be clearer in at least three major petitions in our towns, the largest 40,000. This is all referenced below. As also protest meetings, many dozens of letters and articles in local media, with coverage on local radio and television. Forty years in Poole we have never had such overwhelming opposition to any issue.
And added to this are the Opinion Research Services (ORS) phone surveys commissioned by DCCG. A leading professor in statistical analysis sums up surveys :
“The company (ORS) must 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.”
This overwhelming opposition born out in every respect, in petitions, in public media, in public exchanges. But no less DCCG sum up this huge opposition in the words of the Chief Executive : “Not everyone agrees with our decisions”. That then the understatement of the century and summing up arrays of grossly misleading misinformation from DCCG.
And of course there are all the other closures involved in DCCG transformation : closure of three out of 16 of our community hospitals, three others losing their beds. There is outrage in every town affected. Community hospitals rebranded community hubs but in all this Minister no more staff. No more investment. And likewise surgeries closing, We have lost one of our two main surgeries in our suburb and that clearly the going rate for all suburbs and towns.
We understand the case for centralising with interdisciplinary teams working together, using automated 111 access systems, all efforts to improve efficiency. And the need to have consultants available 24/7 in A&E departments. But in all consideration in a conurbation of the size and spread of Poole, Bournemouth, Christchurch, Purbecks, we cannot reduce down to one major A&E unit with this on the easten most edge of the county.
On then the issues brought up by Cllr d’Orton’Gibson letter 22nd November :
Firstly note the contention the Cllr inflames between Poole and Bournemouth defending his justification to write to your department opposing Poole and Dorset councils referring DCCG plans to your department.
This is beyond extraordinary. Regulations make clear a Local Authority Health Scrutiny committee may refer “proposed substantial NHS development or variation” to Secretary of State “if it considers that the proposal would not be in the interests of the health service in its area”.
The issue is bringing to attention of the Secretary of State disputes in cases where there are substantial changes not in the interest of the health service in a Local Authority’s area. I do not see any mandate to write to the Secretary of State to support degrading services in a neighbouring area, as in the case of Cllr d’Orton-Gibson writing to your office to oppose representation from Poole and Dorset councils.
Be that as it may, Cllr d’Orton-Gibson draws to your attention a Joint Health Scrutiny meetings (Poole, Bournemouth, Dorset) Dec 2017 with a vote and decision not to refer DCCG plans. That then does not give the full picture. The vote was 6 to 4 not to refer which then shocked everyone in Poole (and Dorset). Of three Poole Cllrs in the committee two who were expected to vote to refer abstained. People in Poole shocked on the point all Poole Cllrs voted July 2017 to support opposition to loss of Poole A&E and maternity.
Poole Health Scrutiny is now holding I understand a Health Scrutiny meeting in December with a new motion to refer and in so doing, and approving, will be supporting Dorset council’s vote to refer along with the overwhelming opposition of people throughout the borough.
The whole point of the referral, as stated in the Independent Reconfiguration Panel introduction, to “review proposals for changes to NHS services that are being contested and advise the Secretary of State for Health & Social Care.”
Cllr d’Orton-Gibson and colleagues clearly want to interfere with and undermine this statutory process before it even gets started. And I submit Minister this will be the first case in DHSS history where Cllrs from one council have sort to undermine a health referral issue from a neighbouring council.
There has certainly been very steep learning curves with such enormous transformations of services, every reason that issues are looked at again as people understand more clearly what is involved. Not to stake huge transformation on one Joint Scrutiny meeting outcome then set in stone.
To take then the Cllr’s specific points : paragraph three on ambulance response times misses a dozen key points and for the rest is invention and guesswork. With two A&E hospitals, ambulance stationed at both, and throughout the conurbation, on any distributed analysis you will have lower, not more, ambulance time journeys than with one only A&E centre. In any analysis the larger the number of centres the less the travel distance and times.
Paragraph four the Cllr speaks of getting patients to the “right hospital”. Of course patients need to get to the right hospital with clinicians to deal with a specific emergencies : trauma, sepsis, bleeding, stroke, coronary attack. But equally, not less, patients in time-critical emergencies need to get to the hospital in the shortest time possible. Minutes make all the difference. And not just survival but ending up with irreversible medical harm with disabilities for life.
“Access to A&E ” and “access time” is not an either or situation. We cannot separate one life-critical factor (Access to A&E) and set up against the second life-critical factor, travel distances and response times. A car needs an engine and wheels. Either part missing the system is useless. But this is what Cllr d’Orton-Gibson (repeating the theme from DCCG) is promoting, an either or situation. Making the case access to the right A&E unit “matters far more” as the higher priority than access time when both are equally life-critical.
In this case in Dorset losing one of our two major A&E units far outweighs what might be gained having one only A&E centre and in turn this will cost lives. There is no report from any research body that does not make clear time and again in life-critical emergencies time is of the essence. Figures given make clear every extra mile (at ambulance blue light speed) is 1% more risk to life and irreversible damage. These points are all referenced below.
And it has to be added that whilst not all A&E centres can deal with all emergencies at least all 24/7 A&E departments, without exception, can deal with choking, bleeding, poisoning, panic attacks, and downright human distress. They can stabalise and medicate, all the world of difference having A&E departments within at most 45 minutes of the population of a major conurbation. Not as we will end up with one A&E on the eastern edge of the conurbation with access times up to an hour and a half from western areas 30 miles away.
Notably Cllr d’Orton-Gibson is also promulgating the “80% of A&E cases at Poole will still be dealt with” claim. Passing on what he has read or been told by DCCG. And this a Cllr who is supposed to be scrutinising the plans but turns instead to broadcaster for DCCG.
In any case what is stated is wholly inaccurate Minister. On 2017 figures 68,070 patients visited Poole A&E last year of which 37,478 were admitted as A&E cases.
55% (37,478) of all visits to Poole A&E 2017 were A&E admissions, 45% (30,592) non-admissions which could be dealt with by an urgent care centre. But no less DCCG are leading people to think “80% of current visits to A&E” will be dealt with by the UCC.
That is not correct. The figure is 30,592 current non-admission cases could be dealt with by the Urgent Care Unit. That is 45% of all current A&E cases, not 80%. This figure (80%) is the capacity of the Urgent Care Centre (53,000) as a % of current A&E visits (68,000).
This then is one more case from DCCG of grossly misleading misinformation. It will be possible to treat only 45% (30,592) of current patients in the Urgent Care Centre not 80%. And that means enormous disruption and disorientation for thousands of patients.
Cllr D’Orton-Gibson then brings up the issue of hospital consultants making the point with one centre there will be “greater consultant cover” which will then “very probably” results in save lives.
This then is shear guesswork plucked out of the air.
In any case what we are saying in sum is our national health care system is so enormously underfunded, and overloaded, we cannot afford to staff all our NHS hospitals and therefor, on DCCG and d’Orton-Gibson’s rendition, this justifies closing one A&E on the point we can it seems afford to staff at least on major A&E.
And we are told by Cllr d’Orton-Gibson “failure to reorganise” is going to result in unnecessary deaths. Which is to say our system is so massively running down we have to compare worse with even worse. Can’t afford to fund two major A&E units, can’t afford to keep all our community hospitals, so rather then a wholesale distributed collapse of the whole system we regroup (as at the Alamo) with what we have left in one major centre – the other major centre then decimated (Poole loss of all A&E, loss of maternity, loss of 400 beds).
Notably from this Cllr no thought whatsoever to possibility and finding the energy, commitment, and funding, to run two high quality fully staffed trauma A&E and full maternity units in both our major hospitals. And that is keeping in mind Poole A&E and maternity have outstanding reputations for health care built up over so many decades. Integrated teams of dedicated clinicians based in Poole with families and children in school and this is all to be dismantled in a grand transformation exercise.
To close Minister having spent many years abroad not least in Canada, New Zealand, and Australia, living in UK – Dorset – is as going back to the Middle Ages that we have to fight and struggle to get the most basic of services that progressive countries deliver with little or no difficulty.
Of course we need two major trauma and A&E units and full maternity units at both major hospitals in a 460,000 conurbation. But there is clearly no financial commitment and so it is DCCG work out how to shift £147 million a year from operational budgets to capital investment and reducing underfunding debts approaching £157 million and launches a mass misinformation campaign to sell enormous closures of our front-line medical services to the public as some huge benefit.
The biggest scam on the people of Dorset in a lifetime. Clearly Dr Richard Beeching 1960s Close Down of huge sections of the Rail Networks II – this time our National Health Service.
Enormously unimpressed Minister.
And Cllr d’Orton-Gibson – a property letting industry man. I would not expect stimulating insights into human well-being. I am not disappointed.
Jeff Williams CGFTC BA (Soton) PGCE
28th November 2018
26th November – updated 27th November
Cllr David d’Orton-Gibson
Bournemouth Health Scrutiny Committee
I note the comments of yourself and colleague Cllrs as reported in Bournemouth Echo on the matter of referral of DCCG CSR plans to the Secretary of State for Independent Panel review : Hospital campaigners accused of ignoring facts.
You and colleagues take the view any such referral is unwarranted on the grounds campaigners are “ignoring the facts”.
In reply Cllr below is a comprehensive review and assessment grounded in DCCG documents laying out all the reasons why overwhelmingly the population of Poole, the Purbecks, and large parts of Dorset, fiercely oppose DCCG plans.
Al the reasons why the proposals need as a matter of urgency to be referred to an Independent Panel before the county ends up with emergency critical-time health services inaccessible to tens of thousands in our county.
To give some broad strokes on key issues : And on that move Chief Executive of DCCG can tell us : “I can assure you that we are not cutting the total spend in Dorset on health services”. But what Mr Goodson doesn’t want to say is operational budgets are being cut over five years by £147 million, that then covering capital investment along with dealing with £147 million deficit (£157 million by 2024) underfunding.
It’s like for like run down of operational costs reducing underfunding debt with investment (from what is cut/saved) in one-off £147 capital investment (with government compliance top-up reward of £8 million), largely at RBH.
And so it is out of 17 community hospitals in Dorset we have four closing or closed down (Alderney, Portland, Ferndown, Westhaven), three losing all their beds (DCH, Wareham, Christchurch), Poole A&E (37,000 admissions 2017) and maternity (4,500 births 2017) closing down and losing 400 beds. This the cost of funding the deficit and finding capital funding to expand RBH. And to be noted careful reading of DCCG documents is required, ie “transfer of staff” means close-down.
As for your specific comments Cllr on “real benefits” of DCCG plans backed by “clinical evidence” I would be most grateful if you would cite that evidence, particularly on the largest issue of all downgrading one of two major A&E departments in a huge conurbation to an Urgent Care Unit.
On my serch of DCCG documents and national documents such evidence is non-existent. It does not exist.
Professor Jon Nicholl who led the only research in the country that has ever been carried out on downgrading A&E to UCC, Emergency Department Closures, as cited repeatedly (non-specifically) by DCCG, states 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.”
There is an all too clear case to separate urgent care from emergency cases, but not to close down one of two major A&E departments in a conurbation of 460,000, and growing. That has never been done anywhere else in this country Cllr d’Orton-Gibson by any authority anywhere. The size of the towns in the Sheffield research were between 19,000 and 110,000 – not a 460,000 conurbation, and growing by thousands every year.
And please note in the Keogh Report 2013 driving much of these changes Dr Keogh states : “The number of Emergency and Major Emergency Centres should broadly equal the number of current A&E departments”.
And Cllr Jackie Edwards and all Cllrs in the Scrutiny group, the whole problem of opposition to plans and referral comes down you think to “media misrepresentation”. That is interesting Cllrs so let me state as clearly as I can in many years researching issues never have I come across such a litany of grossly misleading misinformation as is being put out by DCCG. In many instances nothing short of propaganda. Refusal time and again to address fact on fact public scrutiny.
And that is not assertion Cllrs. All the specific examples are listed in detail with references below. And as far as local media I think we should be hugely grateful we have open probing reporting bringing to our attention what is going on in our towns giving both sides of arguments : Bournemouth Echo, BBC Solent, BBC News, ITV Meridian, Dorset Eye – all giving factual coverage of this huge transformation.
In then “blaming” media “misrepresentation” for the overwhelming opposition to DCCG transformation of Dorset NHS I am of course minded of the current incumbent of the White House : the media is all “false information” and this when notably quality US media are fielding near identical criticism.
And same now in Dorset – 50,000 have signed petitions. The population in Poole and into the Purbecks and many parts of Dorset are horrified. The media is expressing these views – with similar reporting. But you are saying Cllr Edwards all the media in Dorset (Bournemouth Echo, BBC South, Solent Radio, ITV Meridian, Dorset Eye) are all misrepresenting the transformation of Dorset NHS. You are not prepared to concede tens of thousands fiercely oppose these mass close-downs of services?
In the end Cllrs on close reading DCCG “changes” means close-down; “merger” means close-down; “re-modelling” means close-down; transformation probably the only accurate descriptor meaning our local NHS is to be transformed out of all recognition. DCCG Integrated Urgent Care system will be access to urgent care through a 111 (and on-line) automated system. And this in due course for GP surgeries. We are heading full scale for 111 call centre automated centralisation. With three weeks training call handlers and call centre agents replacing what would be direct access to receptionists in medical centres.
And in all this the most devastating part of all A&E and maternity is moved seven miles from Poole to RBH with access along the overloaded forever gridlocked A338 which is then as a matter of fact going to lead in life-threatening emergencies cases to more loss of life. On the statistics, from SWAST and other sources, many hundreds or mortalities. This fact is stated repeatedly in all ambulance response time and mortality studies ever undertaken :
Relationship between distance to hospital and mortality : “Our data suggest a 10km increase in straight-line distance is associated with around a 1% absolute increase in mortality”. Swanage to RBH is 31 miles – ten extra miles than to Poole A&E. This then in life-threatening cases near 2% increase in risk of mortality, which is then on a figure of 10,000 life threatening cases a year from Purbecks and Poole, 200 extra deaths a year as a consequence of closing Poole A&E.
Emergency Medicine Journal : “Equality of access to appropriate pre-hospital emergency care is a core principle underlying an effective ambulance service. Care must be provided within a timeframe in which it is likely to be effective”.
A&E Closures in North West London – close-downs nationwide : “Waiting times at neighbouring A&E departments increased sharply after those at Hammersmith and Central Middlesex Hospitals were closed.
FT – Professor Nicholl – Sheffield Research – A&E closures failing to boost patient care : The study’s co-author, Jon Nicholl, professor of health services at ScHARR, said it was important to highlight “that we didn’t find the better outcomes for patients that planners hoped to see from closing these small departments either”.
If you are interested Cllrs in understanding why so many tens of thousands are fiercely opposed to DCCG proposals then please look through or better still read through below. Any points wrong – as I have said to Mr Goodson repeatedly – then by all means do explain where information is incorrect or misleading.
“Misinformation in media and from campaigners” – Mr Goodson’s repeat clarion call – but with little explanation of where exactly information is misleading.
Mr Goodson please answer the following : Key critical question that have not been answered in two years.
26th November – updated 28th November