#63. Snowflakes, please read the writing on the wall…

…the writing that’s been there, in plain sight, for YEARS!

So many people with so much to say and all saying it through their backsides, especially the intensely irritating ‘Save Our NHS’ who have so much to say, all of it selectively picked from articles that support the arguments of its “spokeperson” and which she uses to reinforce the prejudices of her unquestioning supporters.

Well, to balance the argument – insofar as there is any room for argument in the face of the facts – I present two articles taken from the Shropshire Star of three years ago.

 

PUBLISHED: May 14, 2016 07:59

Future Fit: Doctors defend plans for having one A&E in Shropshire

Having one A&E department in Shropshire will mean patients are cared for in the “right place at the right time”, according to senior county doctors.

Consultants from the Shrewsbury and Telford Hospital NHS Trust have said plans for how hospital services will work in the county in future will provide the best care for patients.

It comes after the county’s two clinical commissioning groups threw plans for the future for the region’s two main hospitals into chaos when they failed to agree on whether to back the strategic outline case for Future Fit – the programme in charge of the review into hospitals in Shropshire.

The outline plans suggest one single A&E unit supported by a network of urgent care centres, one diagnostic and treatment centre and local planned care on both the Royal Shrewsbury Hospital and Princess Royal Hospital sites.

No decisions have been made and several options are suggested in the strategic outline case, which is effectively the first stage of the project.

Mark Cheetham, consultant general and colorectal surgeon and scheduled care group medical director, said: “One emergency department doesn’t mean worse access to healthcare. In fact, it would mean greater access to the right people in the right place at the right time. This is better for our patients.

We need to be brave and we need to look at ways of providing the best care for our patients in a sustainable way in the long-term. This isn’t about what is right or easy for us. And it’s not only about what is good for our communities today.

This is a long-term plan which is about providing the best care for our children and our children’s children.

The SOC is a further step forwards towards the development of better health services for Shropshire, Telford & Wrekin and mid Wales.

I have seen at first-hand the benefits that consolidating services can bring. In emergency surgery – which was consolidated on the Royal Shrewsbury Hospital site in 2012 – for instance we now have a team of 11 surgeons who specialise in abdominal surgery.

There is always one consultant free from all other activities to provide emergency care for our patients. The result has been a thriving large department of surgery with improved outcomes.

“I believe that by co-locating key services in an emergency centre, we will be able to provide safer, better care for patients who are seriously ill or injured. “Developing a separate diagnostic and treatment centre will allow us to provide better care for patients having planned surgery with an improved patient experience and a reduced chance of cancellations.

There is much more work to do as we refine our thinking and further develop these plans; I feel it is a positive start that will help to provide the best care possible for our patients whilst resolving some of the issues we face.

The easiest thing in the world would be to do nothing. That would be dangerous.”

“These plans are about ensuring patients now and in the future have the best access to the best medical staff in the best place when they need it, and I fully support that move.”

Dr Kevin Eardley, consultant renal physician and unscheduled care group medical director, added: “The strategic outline case describes options that will improve current hospital services ensuring that the sickest of our patients have access to better emergency, urgent and critical care services.

The reconfiguration of health services between hospitals has been observed locally already for the benefit of patients.

Patients from our region who have sustained major traumatic injuries currently travel to major trauma centres in Stoke or Birmingham. Patients who have serious or life-threatening heart attacks already go directly to Stoke or Wolverhampton.

In recent years at SaTH we have already made successful changes – children with severe illnesses are cared for at the Princess Royal Hospital and patients with major surgical illnesses are cared for at the Royal Shrewsbury.

The driver for these changes has been to improve access to the very best possible care and therefore improve the chances of a full and quick recovery.

Improving access to specialist services requires clinical pathways that direct patients to the most appropriate service where they will be cared for by specialist teams made up of a workforce who have come together, grown their expertise, and are therefore better able to deliver the very best possible care for generations to come.

 

Friday 20 May 2016

We, the undersigned Emergency Medicine Consultants, would like to take this opportunity to clarify our views on NHS Future Fit, The Shrewsbury and Telford Hospital NHS Trust’s (SaTH) Strategic Outline Case (SOC) for its Sustainable Services Programme, and the portrayal of “Accident and Emergency” in the media. NHS Future Fit and the SOC are an attempt to redefine high level medical care to the population that we serve.

We know that having all the services a patient requires on the same site improves the care delivered to that patient and the clinical outcome. We already send patients with major injuries or who have had heart attacks to Royal Stoke University Hospital. These patients have a lower risk of dying and an increased quality of life after being discharged. Within SaTH we have already concentrated emergency surgery onto one site in Shrewsbury and this has led to better outcomes. We now have a death rate below the national average. Acute stroke services are on one site in Telford and again this has improved the care and quality of life for patients who have suffered a stroke. Concentrating the paediatric inpatients at one site in Telford has increased our ability to recruit and retain high quality medical staff, which is better for our patients.

We acknowledge concerns about the increased transport time for patients. However, whilst getting a patient to hospital quickly is important, it’s more important that patients are seen in the right place, by the right person as soon as possible. A bigger more specialist site will mean more high quality staff, meaning patients can be seen by the right person much more quickly.

It’s all very well saying that we should employ more people at our sites, but the fact is our Emergency Departments are not attractive because they are small, with staff preferring to work in bigger state-of-the-art units. A single but larger Emergency Centre will help us to recruit.

At present the majority of patients who present to our A&E do not actually need to be seen there and would be equally well treated in an Urgent Care Centre/Minor injury Centre (e.g. cuts, fractures, stitches etc), which would remain at both sites if the SOC moves forward to Outline and then Full Business Case, as we hope. People would be seen, diagnosed and treated with local follow-up arranged, if required. The proposals would ensure that a high quality service is provided on both sites for the majority of patients who don’t need treatment in an A&E and the remaining patients would be cared for in an Emergency Centre. The Emergency Centre would be able to deliver high quality, life-saving care through a dedicated Emergency Team well supported by other relevant specialities.

Having one Emergency Centre would allow the Trust to ensure there is always one of our own senior doctors present 24-hours-a-day, seven-days-a-week to deliver care compared to the current situation of locum doctors more frequently delivering the care.

This model would also help to keep services in the area rather than moved to the bigger centres in Stoke or Wolverhampton. In addition, it would allow the Trust to be at the forefront of medical research, which it cannot currently do with the present configuration.

Following consultation with colleges from across the region, the ability to recruit and retain experienced, highly skilled staff would be increased – ensuring our patients receive the safest and kindest care possible in the county, rather than having to travel outside of Shropshire and Telford & Wrekin.

Doing nothing is not an option. The current model is not sustainable and change is needed. We must ensure patients now and in generations to come have the best services possible.

Yours

Mr Subramanian Kumaran FRCS, FRCEM, Consultant and Clinical Director for Emergency Medicine

Dr Adrian Marsh FRCEM

Consultant and Clinical Lead for Emergency Medicine, The Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, SY3 8XQ

[and]

Princess Royal Hospital, Apley Castle, Telford, TF1 6TF