Death Rates Increase in A&E Closure Areas

[steveL]

For once a genuinely interesting report in The Mail about how closing local A&E departments can increase death rates. It's an American study but the observations apply equally over here.

http://www.hartlepoolmail.co.uk/news/uk/a-e-closures-affect-death-rates-1-6767651

[Monkeys mate]

It is an interesting article however I don't believe you correlate American and UK health systems. They have a very different way of working. The Uk Studies on the effect of major trauma networks would hopefully report soon but if you look at documents written prior to the instigation of regionalisation there was clear evidence for the need for a massive shake up in the way we do things.
The old system of local hospitals all trying to do the same thing was not having the best outcome for patients. If you combine units there is a greater volume of patients who get an increase in care from specialists who use that increased volume to gain a greater experience in treating you. That's why for years in this region if you need transplant surgery you go to Newcastle, eyes go to Sunderland and major cardiac surgery to Newcastle or James Cook. That system works.

I do believe in the regionalisation of services - as would the people if Hartlepool if it was our General hospital that was saved and North Tees was loosing its services. I can't envisage anyone would be shouting about it from our Borough on behalf of Stockton and Billingham,can you? The number of ambulances available however is a different matter in my opinion.
Interesting, but long reading.......National Audit office, Major Trauma Care in England and the NCEPOD (national confidential enquiry into patient outcome and death) Trauma, Who cares?

[for fawkes sake]

"If you combine units there is a greater volume of patients who get an increase in care from specialists who use that increased volume to gain a greater experience in treating you. That's why for years in this region if you need transplant surgery you go to Newcastle, eyes go to Sunderland and major cardiac surgery to Newcastle or James Cook. That system works. "

I disagree totally with what looks like a totally automatic assumption that you can't use American data in a UK situation. The parameters of the study appear to be completely comparable to me.

I wouldn't disagree with some of what you say but I'm afraid that you are rather missing the point. Such an approach might well work for planned treatment where patients are not under immediate danger but it does not work when you are talking about life-threatening trauma. Which is why people still call for the return of our own A&E Department.

People have been happy for years to travel to Sunderland Eye Infirmary etc and they see the logic of it but they do not see the logic of the present 'Games and Ladders' qualifying rounds that are now necessary to go through before eventually being allowed to receive A&E treatment.

You could argue that more experienced specialists would be available at centralised trauma units and that if you manage to make it to one of those units your chances of survival will therefore increase - but you have to make it to the unit first.

It's not just delayed ambulances that have been the cause of problems. We have had far too many examples of  misdiagnosis at One-Life for anyone to feel safe in the present circumstances. Meningitis, fractures and strokes have all been missed by One Life personnel and it's coverage hours mean that the place never has amounted to much more than being a shopping centre first aid hut.

There is confusion as to where to go when facing a sudden illness or accident; confusion not only from patients but from One Life Centre staff too, who habitually fall back on the you need to go to North Tees' cover-all statement; confusion too from non-medically qualified 999 Centre operators who rely on scripts and computer based question and answer screens to decide whether someone life is under imminent threat.

Perhaps it's true that the life of an 80 year old women, lying out in the open on a wet pavement for two hours is not under imminent threat - but perhaps it will be tomorrow having been put through such an ordeal. Perhaps, in any case, treating people in such an inhuman, disrespectful way isn't the right thing to do . A human being would understand that - a machine never will.

     

[Monkeys mate]

hi Fawks
I agree with you other than the centralised a&e point. Specialist Trauma Centres (JCUH & RVI) and the trauma unit set up DO work. However, I agree about access to that care.

As i said the ambulance situation and primary healthcare system is a major issue. How people access the A&E system currently is very poor, and in my opinion getting worse. The number of ambulances, with qualified Paramedics,  that can transport people to the most appropriate hospital has reduced. In hartlepool you will regularily see non-nhs ambulances attending the work of nhs paramedics. If you call 999 now you may get a Paramedic or it may be a St John crew or Red Cross ambulance without the skill of a Paramedic

On top of that the A&E system is slow as it is full of patients that are unable to see their GP, redicected by NHS inept or 111 or many who should have been dealt with in a primary care center like One life. ( I have never been so i am unable to comment on their care but i would suggest that many people go there when they really should have gone somewhere else- and i agree, maybe its because they are unsure what to do).

Obviously there are also patients that shouldnt be in A&E at all - regular and persistent time wasters.

The reduction in ambulances, either due to lack of available vehicles or through misuse is a major problem - and i agree, exacerbated by a longer distance to travel however, if we stayed with old system of local general hospitals then those patients that need immediate trauma care from a cross specialty team would suffer and continue to die. Multiple major trauma patients are surviving in greater number because of a multi disciplinary team approach and the return to the old days of 'we can treat part of you but for the other bit you need to travel, in critical condition, to another hospital' then we will return to the mortality rates we had then. Yes, those patients travel that far now, but that system of every specialty in the same place saves more lives.

It would be great if Hartlepool could have a Major Trauma centre like JC or RVI, but it wouldnt help with the reduction in ambulances, the lack of correct information of which of the many options to choose or a non-time critical patient waiting hours for an ambulance, who then, as you point out, becomes life threatening just through the ordeal. As the boss of the ambulance service said recently there isnt enough money to run a service that we need.

Thanks for a stimulating discussion, I do agree with most of your points. Unfortunately those who purely shout for an A&E in hartlepool are missing the point - that system didnt work either, other than being a local hospital for local people. I know its what we are used to but it had to change - now we just need to change ambulance funding, the walk in centres, the out of hours cover..............................................

[grim reaper]

FFS, I totally agree with your comments.
A town of our size (and growing, otherwise why the need for all those extra houses???) needs its own hospital and A & E.
I would surmise the volume of people in Hartlepool and the South Durham area that used to 'feed' Hartlepool General exceeds the people of Stockton.

So why did Stockton manage to keep their outdated and grubby stalag hospital? Because THEIR Labour MP shouted loud enough for it.
It's all been said before, ad infinitum. We will never have decent facilities in this town until we vote out the stooges running/abusing it.
Will it happen? I very much doubt it.
33% have and will always vote for a Labour puppet. The other 66% simply can't be bothered to get off their backsides and vote.
If only they would, things could start to move forward in this town of ours.

But the hospitals; ours looks as fresh as any newly built unit.
The stalag in Stockton looks like a grey, concrete Russian prison.
YUK.

[Inspector Knacker]

If you have two A&E's and close one, you have twice as many patients. So unless you increase the number of staff along with the number of ambulances you have a problem .
It's ok waffling on about specialist treatment ....but what percentage of patients require that so called top end treatment....?
One Life ...?  forget it. You might as well cut out the middle man and head for North Tees.......if you have a car that is.

[Monkeys mate]

Sorry  if I waffled. Whatever the percentage is one day when you or a loved one needs  this 'so called top end treatment'  you will be glad your chance of survival has increased because of this system.
As I waffled earlier, I'm not defending the rest of primary care - but keeping multiple smaller hospitals, like our a&e was not working and the survival rate has increased.
Waffle over

[Inspector Knacker]

I don't recall saying you waffled. Your post does however bear an uncanny resemblance to a script from a persistent Mail scribbler lecturing us on the joys of North Tees.

[Monkeys mate]

  I'm shocked and stunned that anyone would think I would stoop so low as to buy that rag let alone write to it!
I can assure you it isn't me. I have recently joined this forum to have my say and that is it. You may pick up on the fact that I work within the health care setting and I completely disagree with many of the things that happen from a healthcare point of view but I do support some others from a clinical and evidence based point of view.
I'm not here to rant and wouldn't be seen dead in that thing that was once a good journalistic medium. Unfortunately in my middle age I'm too young to remember when that was 

[steveL]

The public will always be protective of their own NHS services, rightly so, in my view. There was only ever one chance that the people of Hartlepool would willingly and eventually go along with the closure of their own hospital and that is if it could be proved that the end result was better than what they started with; that patently hasn't happened.

It was down to the high paid executives behind the Momentum plans to make sure that their plans were so well integrated and thought out that Hartlepool would be left with a superior service that was easily accessible to all and which could demonstrate increased levels of care.

Let's just say they blew it.