Collingham Comment

NHS Review

What does the Newark Hospital review mean to the people of Collingham and the surrounding districts?  I emailed the Primary Care Trust (PCT) and asked a couple of questions, we’ll come to that later where I quote the email and the replies in full.  Whilst I was doing that, other people were asking questions too, and there’s a list of them on the NHS Nottinghamshire County website if you can find them amongst all the propaganda. (This should help.)  It’s interesting to see that many of the questions remain unanswered; for example:

“Q   Will the people of Newark now face an arduous thirty minute journey of extra pain and risk to life if these proposals are allowed to go through?  How many people have died on route to KMH, QMC and Lincoln Hospitals because of lack of Heart attack care at Newark?

A   Doctor Andrew Molyneux, Service Director for Emergency Care and Consultant Physician, said: ‘All doctors are in agreement that if a patient suffers a heart attack there is now a better treatment called primary angioplasty.  This requires the patient to be in a specialist centre, with state-of-the-art equipment, facilities and with doctors who have unique skills.  This saves more lifes(sic) and improves the patient’s quality of life.”

Doctor Andrew Molyneux carefully sidestepped the question about deaths en route.  It’s patently obvious that the emergency facility at Newark is no longer going to be referred to as an Accident and Emergency unit, but will in future be called a Minor Injuries Unit (MIU).  The only choice we have is whether it is open twenty four hours a day, seven days a week, or whether it opens from seven in the morning to midnight, or at least we’re told we have a choice, I wonder…  I’m sure the latter would be the preference of the PCT, but I think the people of Newark and the surrounding area may well have something to say about that, it will be interesting to see if what they say has any effect.

I quote the PCT’s proposals in full:

“Option 1 – Minor Injuries Unit ‘Plus’ 24/7
A minor injuries unit ‘plus’ (MIU) is staffed by doctors and specially trained nurses to treat people with minor injuries such as broken bones and minor illnesses.  There is access to X-ray and other testing equipment.  A direct secure online link to other centres allows the results to be read by experts immediately for them to give advice if necessary.  An out-of-hours GP service would also be available.
This means we could provide the same level of care that is currently available at Newark.  As a result, 85% of patients would still be treated there.  The other 15% would be taken directly to another hospital by ambulance, reducing transfers and ensuring patients get to the ‘right place, first time’.

Option 2 – Minor Injuries Unit ‘Plus’ 7am - midnight
This would be the same as above but only open between 7am and midnight, with out-of-hours GP cover enhanced.”

To be honest, I have no problems with the A&E unit being called a MIU (the “plus” is just window dressing), that has essentially been its function for some time now; I don’t even have a quarrel with the “right place first time” ethos.  The first bit that worries me is the idea that the cover provided by an “out of hours GP service” would be adequate.  If it is anything like the out of hours service I’ve had experience with in the past, it will be provided by the private sector, difficult to access and prone to extremely long delays.  When the doctor does arrive it’s quite possible English will not be his first language.  (Just as an aside, the out of hours nurses were great, it was just the doctors that were difficult to access.)

The second thing that worries me is if some sort of political bias is introduced to the system, meaning patients have to endure longer journeys than necessary by being taken to King’s Mill rather than Lincoln.  Lincoln County Hospital is much nearer to this part of the county than any of the others, but there are no guarantees as you’ll see later, it is also run by a different PCT.

The third problem is much more fundamental.  The road from Newark to King’s Mill has to be one of the worst in the county.  This means that for cases of major trauma, the Air Ambulance would be the best option, but if you have a heart attack or stroke, you have to suffer a long and unpleasant journey by road.  This also means that the ambulance you are in is out of service for at least two hours.  Funnily enough, from Rainworth to King’s Mill is a lovely new road, it’s just a pity some of that investment doesn’t come to this side of the county, but that’s another Collingham Comment all of its own!

Anyway, here’s the reply to the email I mentioned earlier.  I don’t know if Karlie Thompson has any ambition to be a politician, but she’s certainly developed all the skills, I’ve also corrected the spelling mistakes this time, my questions are in the numbered paragraphs and a different font.

“Dear Mr Ozbourne,
Thank you for your enquiry.
Here we have answered your direct questions:

If you were to suffer a heart attack, the medical evidence, new national guidance and doctors now advise that you need to be at the right place, first time, in terms of your treatment and care.
At present EMAS would take patients from Collingham to the nearest hospital, and we generally take any patients not suitable for Newark to Lincoln.  However, regional specialised centres for heart attack and stroke patients are to be introduced.  If Lincoln becomes one of those centres we will still take Collingham patients there.  If it doesn’t, we would take patients to wherever the centre is located.

The national ‘Next Stage Review’ points out that these specialist centres need to be spaced out across the County and regions, so that wherever you have a heart attack you are within a set distance. The exact locations of these centres is still being finalised - please may I refer you to: http://www.excellence.eastmidlands.nhs.uk/  I can offer you reassurance that the ambulance crews would ensure you were taken to the best place for your condition.

    2   What improvements are going to be made to the ambulance service to ensure that patients from Collingham are attended within national guidelines and reach hospital within a reasonable time?  At any given time, how many ambulances are available in Newark?  Are there enough to ensure cover for emergency patients from outlying villages on a Friday or Saturday night?

EMAS is required to respond to 75% of all ‘category A’ life-threatening calls within 8 minutes.  There are no targets in relation to the amount of time taken for patients to arrive at A&E. 
Currently, EMAS’ minimum resource level for the Newark area is two double crewed vehicles and one fast response car.  These are supplemented by clinical managers who also operate as solo responders.
NHS Nottinghamshire County is working in partnership with EMAS to identify what additional resources may be needed under the new proposals to allow EMAS to achieve its performance targets.
The clear medical guidance is that is better for patients to get the ‘right care first time’, even if that is in a specialised centre slightly further away. In fact, the Next Stage Review changes are specifically designed to ensure that people who have had a stroke or a heart attack get the right treatment (clot busting drugs or angioplasty) within a 3 or 4 hour window. Worldwide research has shown that this saves lives and improves patients’ chances of a full recovery.
I hope this is helpful.
Thank you and kind regards,
Karlie Thompson
Deputy Director of Communications & Engagement
NHS Nottinghamshire County
External: 01623 673131 (Direct Line)
Internal: 43131
Switchboard: 0300 300 1234”
Email: .(JavaScript must be enabled to view this email address)
http://www.nottspct.nhs.uk

My cynical side is emerging again I’m afraid, they can’t even get an ambulance to Collingham in eight minutes now, let alone South Scarle or Spalford, so that isn’t going to change.  If they’re having a busy Friday or Saturday night in Mansfield, we’re on our own as usual.  If it takes in excess of an hour to get an ambulance to heart attack victims in Newark (as happened twice within recent weeks), we poor suckers out in the boondocks don’t stand much chance.  Notice the line, “There are no targets in relation to the amount of time taken for patients to arrive at A&E.”  Even if you get an ambulance to pick you up, the possibility of getting to the ‘right place first time’ within the first hour looks pretty remote. The bit about “new specialist centres” makes me feel uneasy too, decisions are being made without access to the full facts.  Having said that, I’d be prepared to lay odds that King’s Mill will be one of them, they’ve spent £320M on the place so they now have to justify that and hike up the throughput.  Lincoln County should be one, but I’m sure logic will have little to do with the decision.

EMAS image

Then we come to, “Currently, EMAS’ minimum resource level for the Newark area is two double crewed vehicles and one fast response car.”  Are they trying to tell us that if one ambulance is en route to QMC and one to King’s Mill there will be two more ambulances moved into the area and capable of reaching Spalford in eight minutes?  Even if we let them off with the fall back target of nineteen minutes I seriously doubt they will ever achieve it unless it’s a very quiet shift.

It’s possible a unit could be sent from Lincoln, but again I believe eight minutes is unachievable.  Nineteen minutes should be possible; it all depends on where the units are when the call comes in.  The only snag is that Lincoln EMAS has its own control room rather than using the new one in Nottingham; I’m not too sure how “joined up” the two control rooms are.  I must at this point state emphatically that I have nothing but praise for the crews who man the ambulances, any quarrel I have is with the management of an organisation that can take in excess of an hour to reach a patient in Newark town centre.  I would also like to say that in my opinion Collingham Medical Centre provides some of the finest primary care in the county.

In order to try to find out more about how homogeneous the group was, I telephoned and emailed a Mr Phil Morris, Communications Manager for Derbyshire and Nottinghamshire EMAS.  He was out of the office when I phoned and so far I’ve received no reply to the email, so it’s probably best to assume they work as separate entities.  Just for fun, I used Google Maps to work out the distances and journey times to the various hospitals from Collingham Medical Centre, the results were as follows:

 

Queen’s Medical Centre30.4 miles48 minutes
King’s Mill Hospital27.0 miles46 minutes
Grantham Hospital20.8 miles28 minutes
Lincoln County Hospital13.4 miles27 minutes
Lincoln County Hospital17.9 miles31 minutes

I’ve included Lincoln County twice for a reason, the first entry is via the city centre, the second is by the longest route all the way around the bypass.  I’m pretty sure those times could be improved upon by an ambulance using “blues and twos”, especially to Lincoln County.

To sum it all up, you can more or less guarantee that Collingham and its rural neighbours fit into the 25% of call outs that need not be attended within the Category A eight minute deadline (pun intended).  We will continue to be sent to King’s Mill despite the poor accessibility.  Personally, I’m not convinced this whole process is driven by patient need.  If you disagree with me or would like to add to this article, please email me.

Email

Follow up email from EMAS

“Dear Mr Ozbourne

Thank you for your follow-up email.  I have no trace of receiving the first one dated 25 January. However, I have been experiencing some problems with my email and so that may be the reason. Please accept my apologies for this.

In response to your query, I have taken this up with colleagues and been advised that our databases aren’t configured to give performance reports by specific geographical areas. This is because EMAS is required to report on performance across the whole area we serve over a 12 month period – not by any one particular geographical area over a specific period of time (the same applies to all UK ambulance services).

In relation to the likelihood of an ambulance being sent from Lincoln to Collingham, we aren’t able to predict this as it depends on a host of different factors.  To provide the best possible service within the resources available to us, we do make use of use of dynamic standby points to anticipate demand and respond accordingly. If resources are available, then they are despatched accordingly.

I would like to emphasise that NHS Nottinghamshire County is working in partnership with EMAS to identify what additional resources may be needed under the new proposals.

Phil Morris

Communications Manager”

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