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Health Service Forum South East
Minutes of regular meeting of Health Service Forum S.E. held in the Larkfield Centre
on Tuesday 12 October 2004 at 7.30 p.m.
Contents
Report on the A& E Seminar 15 October 2004
Welcome
Welcome from the Chair.
Apologies
Mary Hamilton, Pat Lally, Dan MacPhail, Douglas Macgregor
Minutes
Minutes of 14 September were adopted as correct.
Matters Arising
Matters arising; A report on the GGNHS Board Health Day and AGM of the 23 September was submitted by Dan MacPhail and read out by the Secretary. Dan reported that less than 100 people attended the GGNHS AGM. Both Dr Jean Turner and Tommy Sheridan asked questions. Dan asked why the Board feels it is a good idea to build a stand alone ACAD when there are no other ACADs of this type in the world? In reply he was told that the Middlesex Hospital and ACAD do not share the same site only the same parking area .The two buildings are 400 yds. apart. The ACAD is virtually stand alone. Prof Arbuthnott said there were rumours that the new ACADs would have no beds. Certainly they will have beds but the hospital will close by 9 p.m. and patients will go home. Other questioners asked whether the Board would reconsider some of their decisions. The reply was that the Board felt that they had taken sufficient time to consider these changes and they had gone too far to review theses decisions at this stage.
Our Comments:- The Middlesex ACAD is on the campus of the acute hospital, not six miles away!
The ACAD will have no overnight beds. The hospital, including the minor injuries unit, will close at 9:00pm Mon thru Fri. and all day Sat & Sun.
Mr Chisholm changed his decision on the Fort William hospital. GGNHS must learn to change their decisions, especially when they are not in the interest of patients!
Correspondence In
a) All Lib-Lab MSPs acknowledged receipt of the request to meet with them and a mutually suitable time has yet to be arranged.
b) After representation to GGNHS Board the Forum are now allowed two delegates at the A&E review meeting on the 15 October instead of the lone representative originally invited.
GGNHS Board Meeting
A report was given on the GGNHS Board meeting of the 12 October.
The Board is launching a new campaign to deal with MRSA infections in hospitals. Cross boundary discussions are ongoing with the Argyll and Clyde Health Board. The outcome of the Accountability Review 2004 is as follows; The Minister has decided that future accountability reviews will be held in public. The Auditor General has had difficulty in trying to track where additional investment had gone. The minister has asked for a paper to be prepared in relation to the last two financial years. He wants attention paid to the core of allocation, not just the uplift. Mr Divers replied that the Board is “well able to respond”.
The Consultation on Community Health Partnerships ends on 31 October. NHS Lanarkshire are going for a stand alone CHP for Rutherglen/Cambuslang. The ‘scheme of establishment’ for CHPs should be brought to the Board in December.
Yet again there was a suggestion that the presentation of Waiting Times was to be altered. Recruitment is still proving to be difficult. Figures here are better than down south for out-patients and in day cases, but the reverse is true for in-patients. A scheme using extended-scope practitioners (Physiotherapists) is being trialed. Referrals are seen by a physio and not by a consultant, freeing the consultant up for surgery. This is being rolled out to Primary care in Clydebank and Springburn where physios are working with GPs.
Currently there are 20,546 out-patients waiting longer than the national target of 26 weeks maximum.
The GGNHS Board have a deficit of £58 million yet the director of finance has not attended a Board meeting since May.
We are being told that Scotland has too many hospitals. Dr Mathew Dunnigan has analysed the figures and indeed there are three times as many hospitals per capita compared to England. However if the geographical areas covered by these hospitals are compared Scotland is three times worse off than our counterpart in England!!
Treasurer’s Report
At the Demo the sum of £301 was collected and East Renfrewshire has awarded the Forum the sum of £250. The current balance in the bank is £1045.40.
Public Meeting
A public meeting was organised for residents of Eastwood by Jim Murphy MP and Ken Macintosh MSP and took place on Thursday 7 October at 7.30 p.m. in the Clarkston Hall. The speakers were GGNHS Board members Tom Divers , Robert Calderwood, Dr Brian Cowan, Tim Parke (A& E Consultant SGH), and Graeme Gillies (Anaesthetist).
There was a power point presentation followed by question time. The new design of the four storey high ACAD was illustrated. We were advised that the area of the site is now 10 acres and that there will be underground parking. 60 beds for rehabilitation patients will be on the site. Mr Murphy was quoted in the Extra newspaper as welcoming the 60 beds at the ACAD. We understand that these beds are not for patients having undergone surgery or investigation at the ACAD and have asked Mr Murphy to clarify his statement. Approx. 400,000 people annually will use the facility. The building should be completed by winter 2007. When questioned on the safety of having the A&E facility for the south of the city at the Southern General Hospital, Tim Parke emphasised the need for every ambulance to have a paramedic on board. At present only 60% are manned by a paramedic. On a previous occasion Mr Parke had stated that some 300 beds would have to be provided at the Southern General Hospital before the A&E department was closed at the Victoria Infirmary.
A.O.C.B
Mrs E Bashir volunteered to attend GAMH meetings on behalf of the Forum. The Secretary to provide her with details.
Report on the A& E Seminar 15 October 2004
The meeting was called by the GGNHS Board. The meeting was chaired by Dr Brian Cowan Medical Director NHS Board /South Glasgow Division.
Presentations were given as follows;
Catriona Renfrew, Director of Planning and Community Care NHS Board spoke on the review of assumptions underpinning the A&E services in Greater Glasgow. The arrangements for Greater Glasgow will be;
· Two A& E departments will be retained - at the SGH and the Royal Inf.
· There will be a trauma centre at the Gartnavel which will receive GP referred emergencies and surgical emergencies.
· All children will be attended to at Yorkhill
· There will be five Minor Injuries Units - at the Victoria and Stobhill ACADs, SGH, Royal Inf and Gartnavel.
· The MIUs will be staffed by Emergency Nurse Practitioners
Ray Hepburn (Scottish Ambulance Service) on Ambulance issues
Dr David Stewart (Consultant physician) on Acute medical receiving
Mhairi Lloyd (Emergency Nurse Practitioner) on Minor Injuries Units
After a question and answer session the audience was split up into 6 groups each with a facilitator and a scribe. The outcomes of discussion were fed back to the meeting by each facilitator and noted by Catriona Renfrew. There were a great many misgivings about the assumptions which underpinned the recommendation to reduce A&E departments from 5 to 2. The chairman gave an undertaking that the draft minutes would be issued to all delegates. The minutes have not been received by the 2 November.
Attached is a contribution from Dr Mathew Dunnigan on the relationship between the safety of an A&E department and its size (see below). This article is also available on our web site along with recent papers and articles in the press. Our web site address is www.healthforumglasgow.org and can be accessed on the computer at your local library at no cost.
Next Meeting
The date of the next meeting is Tuesday 9 November 2004 at 7.30 p.m.
Relationship between the safety of an A&E Department and its size
The following summary reflects a broad consensus view of the relationship of the size and organisation of Accident and Emergency Departments in NHS hospitals to safety, based on interviews with a Senior A & E Consultant who has contributed to standard settings for A & E departments on behalf of the British Association for Accident and Emergency Medicine (BAEM).
Incident to door time
The Committee recommends that maximum Ambulance transfer time from the site of an accident or life-threatening illness to an A & E department should not exceed 20-30 minutes. It recognises that this may be difficult to achieve in rural areas. If a department staffed by A & E consultants is not available within this time, the patient should be taken to a casualty or admissions unit where resuscitation and stabilisation facilities are available. This implies the availability of doctors with these skills. They may be physicians, G.P.’s or Senior Nursing staff with A & E skills. Minor injuries units staffed only by nursing staff cannot fulfil this role.
A small minority of A & E attendances with life-threatening illnesses require rapid access to A & E departments. About 2% of all attendances fall into this category, the majority with acute medical emergencies. These include acute myocardial infection, severe/life-threatening asthma, meningitis in children, paracetamol overdose, and coma of uncertain aetiology where life support is essential. About 0.5% of all admissions to A & E departments result from major life-threatening trauma which may require advanced life support. The proximity of resuscitation and stabilisation facilities (including these provided by trained ambulance paramedics en route) within 20-30 minutes of transfer from incident to hospital is of paramount importance in these situations.
Optimum “safe” size of A & E units in NHS Hospitals
Consensus evidence indicates that the clinical outcomes of A & E patients treated in a department with about 50,000 attendances per annum from a catchment population of 200-250,000 are not significantly different from outcomes in a large A & E department with a catchment population of about 500,000. For smaller populations, admission or casualty units staffed by doctors, as noted above, permit stabilisation and resuscitation, triage, and the rapid transfer of seriously ill patients with major trauma through managed clinical networks to specialised centres (e.g. for major neurosurgical problems such as severe head injuries). There is no well founded evidence that very large A & E departments with six or more A & E consultants have significantly better clinical outcomes for the 98% of patients who can be managed within A & E departments of moderate size. The latter comprise the great majority of A & E departments in NHS hospitals in the U.K.
Conclusion
The ‘safety’ argument being used to advocate two large A & E departments for GGHB hospitals is not supported by evidence of clinical outcomes in well-run moderate-sized A & E units which are the U.K. norm. There are also significant risks in reducing hospital A & E services to nurse-led minor injuries units in hospitals as proposed by GGHB and other Scottish Health Boards which are unable to provide immediate resuscitation and stabilisation for the small minority (about 2%) of patients with life-threatening medical and surgical emergencies. Their establishment will place many areas of Scotland (and GGHB’s catchment area) outwith the 20-30 minute incident to door standard recommended by the BAEM for major emergencies, particularly at times of peak traffic flow in urban areas.
