#14. So who needs a life anyway?

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First appeared in the Highley Forum and Highley News, December 2015

There is an awful lot of rubbish being talked about the closure of one A&E over Christmas. I wish the people peddling that stuff would get a grip on the facts. It’s not as if they’re not out there. There are no such plans.

In common with NHS organisations nationally, Shropshire (and Telford & Wrekin) face immense challenges in recruiting the skilled medical staff needed for the vital, highly specialised work that takes place in A&E departments and the other hospital teams that work alongside them.

Plans for health and social care (the two are that closely linked) need to meet the changing needs of patients and communities, particularly as many of us are living longer with long term conditions.

It is a massive challenge to maintain services in their current configuration. Clinicians agree that the best and safest way to keep vital services in the county for the most life-threatening illnesses and injuries is through a network of urgent care centres supporting a single emergency centre. I challenge anyone to explain how we continue maintaining local services in a way that brings together skilled doctors, nurses, therapists, scientists and much more besides, to give the best life chances following major injuries or serious illness without acknowledging the imperative to change to meet the goal of providing the best possible care and outcomes for patients.

We have got to be realistic about where we are. The challenges we face are real. Every day doctors, nurses and the managers who support them are working hard to deliver great care in a way that simply isn’t fit for the future. The challenge to make it fit for purpose is what ‘Future Fit’ was all about.

Future Fit faced huge issues, challenged by the fact that we are a rural county subject to all the disadvantages of rural isolation, on top of which A&E seemed to dominate the agenda.

I’ve always been conscious that it was hardly ever explained that maintaining A&E provision across two sites wasn’t all about money, but A&E staff having a life. The simple fact is that the NHS simply cannot recruit people to work in the emergency sector. In 2011/2012 the specialty achieved a lower than 50% fill rate into higher training. Fewer trainees are opting to choose Emergency Medicine for higher specialty training due to concerns over the intensity and nature of the work, unsociable hours, working conditions and the sustainability of such a career to the age of 68.

That’s why there is a national shortage of A&E consultants. It is not about money. A briefing paper published by the College of Emergency Medicine established that to ensure a consultant presence for 16 hours a day, 7 days a week in all Emergency Departments and 24 hours a day, 7 days a week in larger departments or Major Trauma Centres, each hospital would need a minimum of 10 such consultants – each hospital. And note, that cover was for just 16 hours a day. Nationally, the number of consultants in each hospital emergency department now is 4.7 – in each hospital. In Shropshire there are FIVE A&E consultants over BOTH hospitals. We actually have seven because two consultants came out of retirement when they realised how bad things were!

Now, who was talking about keeping things the way they are?