Save Poole A&E and Maternity – a Matter of Life and Death

Our Statement to Swanage Town Council on Monday 29th October

Town Councillors may know that on 17th October Dorset Health Scrutiny finally voted to refer the CCG plans to downgrade Poole A&E and close Poole Maternity to the Secretary of State for Independent Review.

We are delighted that the referral is being made, and I wish we in Swanage could now simply celebrate the fact that Dorset Health Scrutiny, after a year of lobbying, has finally decided to refer these plans.

However, we are still seeking support from Swanage Town Councillors, to lobby Dorset Health Scrutiny, to ensure that the formal submission to the Secretary of State fully reports and evidences the risk to residents posed by the plans to downgrade Poole A&E and close Poole Maternity.

We have previously reported that the CCG calculated for the High Court, based on the Ambulance Trust Report, that 396 residents per year are at risk of harm if A&E and Maternity services are not provided at Poole, and residents have to travel further to access these services.

A Dorset A&E has scrutinised the cases in the Ambulance Trust Report, and has identified that just under half are in imminent danger of dying, so that any longer journey would have been likely to prove fatal. This scales up to 183 patients a year likely to die. That’s one person every other day.
Please see list of cases provided below. It is quite clear, even to a lay person, that in many cases the patient is close to dying.

We also know that the Ambulance Trust Report can only underestimate the risk, as it only considers emergencies arriving at Poole by ambulance.
From FOI’s, we know that Poole treated 590 Maternity emergencies last year, and 80% did not arrive by ambulance.
We know that 80 newborns received Intensive care at Poole Specialist Neo Natal Unit, and 171 received High dependency care. This level of newborn care will only be available at RBH for the whole County under the plans.

The CCG has failed to address this known risk to residents for over a year.

It also became clear at Dorset Health Scrutiny on 17th October that this risk, explained in detail with supporting written evidence at the Task and Finish Group on 22nd August, had not been reported in the Meeting Notes.

It will be an absolute disgrace if the risk to residents that is clearly evidenced by the Ambulance Trust Report does not appear in the formal submission to the Secretary of State, as evidenced risk to life is the prime reason for referral.

Please can Swanage Town Councillors, particularly Councillors Morris, Suttle and Trite, lobby Dorset Health Scrutiny to ensure that the formal submission to the Secretary of State fully reports and evidences the risk to residents posed by the plans to downgrade Poole A&E and close Poole Maternity.

CASES FROM THE AMBULANCE TRUST REPORT where a Dorset A&E Dr has assessed that the patients are in imminent danger of dying, and that if A&E and Maternity services were not provided at Poole, the longer journey time to access these services elsewhere would have been likely to result in fatality.

1) Overdose non opiate Adult, 90
Overdose zopiclone and paracetamol
Facing 21 minute longer journey
Potential Harm – Yes – reducing Glasgow Coma Scale (GCS) and difficult airways management

2)Sepsis Adult, 95
Chest sepsis – aspiration
Facing 21 minute longer journey
Potential Harm – Yes – red flag sepsis with shock, Glasgow Coma Scale 3, peri-arrest, 21 extra minutes without antibiotics

3) Haemorrhage Adult, 91
Large rectal bleed
Facing 20 minute longer journey
Potential Harm – Possible large PR bleed, hypotensive and becoming shocked

4) Overdose – unspecified Adult, 42
Mixed overdose
Facing 18 minute longer journey
Potential Harm – Possible – fluctuating Glasgow Coma Scale requiring airway intervention

5) Overdose – unspecified Adult, 49
Unresponsive
Facing 17 minute longer journey
Potential Harm – Yes – airways management difficult

6) Trauma Adult, 33
Knocked over by car? Knocked out.
Facing 14 minute longer journey
Potential Harm – Yes – agitated and dropping Glasgow Coma Scale

7) Diarrheoa and vomiting Adult, 82
D&V sepsis
Facing 14 minute longer journey
Potential Harm – Yes – very hypotensive despite fluids

8) Sepsis Adult, 83
Chest infection – likely sepsis
Facing 14 minute longer journey
Potential Harm – Yes – red flag sepsis with shock, Glasgow Coma Scale 6, peri-arrest, extra minutes without antibiotics

9) Stroke Adult, 85
?Cardio-Vascualar Aneurysm
Facing 14 minute longer journey
Potential Harm – Yes – increased travel time with unconscious patient needing CT scan

10) Neurological Adult, 84
Cerebro vascular event (CVE) haemorrhaging
Facing 9 minute longer journey
Potential Harm – Yes – Reduced Glasgow Coma Scale with possible CVE event

11) Stroke Adult, 89
?Stroke or TIA – mild improvement
Facing 9 minute longer journey
Potential Harm – Yes – confirmed cerebro vascular event although still within window

12) Cardiac arrest Adult, 76
Cardiac arrest after ambulance arrived
Facing 4 minute longer journey
Potential Harm – Possible, difficult to do CPR in moving ambulance for further minutes

13) MATERNITY Haemorrhage after birth
No pulse improved en route
Facing 9 minutes longer journey
Potential Harm – SWAST left blank

14) MATERNITY Ectopic pregnancy Extreme hypotension systolic bp 66mHg, pain score 10/10 Facing 19 minutes longer journey
Potential Harm – SWAST left blank

15) CHILD Multiple Convulsion
Remained Glasgow Coma Scale 3 (unresponsive)
Facing 9 minutes longer journey
Potential Harm – SWAST left blank

16) CHILD Cardiac Arrest
Post cardiac arrest
Facing 4 minutes longer journey
Potential Harm – SWAST left blank

17) CHILD Medical
Very sick child
Facing 4 minutes longer journey
Potential Harm – SWAST left blank

Councillors should also be aware SWAST actually identified 696 Adult cases at potential risk. The 12 adult cases above come from a sample of 150 of the 696 Adult cases, as the Ambulance Trust did not have enough time to review the 696. 12 likely to die out of 150 scales up to 51 likely fatalities out of the 696 adults at potential risk of harm.

This means that over the four months of the Ambulance Trust Report:

56 Adults, 2 Mums to be and 3 Children = 61 patients were likely to have died if Poole Trauma A&E and Poole Specialist Maternity was not there.

This scales up to 183 patients arriving by ambulance likely to die per year if Trauma A&E and Specialist Maternity services are lost at Poole.

Defend Dorset NHS