It is not much use having excellent specialist consultants available at a hospital if patients die before they get there, or a woman has to endure a complicated birth in the back of an ambulance.
This message was repeated again and again at the meeting at The Fountain Hotel in Hawes on Monday evening (August 1) at which Edmund Lovell outlined the objectives of the Better Health Programme envisaged by the NHS in Darlington, County Durham and Tees. Mr Lovell is the associate director of marketing and communications at County Durham and Darlington NHS Trust.
He emphasised that they had not yet reached the consultation stage but did want feedback on the various issues raised by doctors working in the hospitals in that region. These issues, he said, included the provision of high quality 24/7 services at a time when fewer junior doctors and consultants were available and the financial restraints within the NHS.
There had also been a considerable move towards specialisation in the past few years and consultants wanted assurance that there would be sufficient work for them to maintain their specialist skills, he said.
To meet national guidelines by having consultants available 24/7 the Trust had already been centralising some specialisations. An example of this is that most heart, stroke and trauma patients with life-threatening symptoms are now taken to the James Cook University Hospital in Middlesbrough.
He accepted that this caused problems for those who lived furthest away from Middlesbrough. Local residents reported that in Wensleydale this had led to long waits for ambulances to arrive.
There was considerable concern about the possibility of losing not just the 24/7 A&E unit at Darlington Memorial Hospital but also the consultant-led maternity and paediatric services there. Residents in North Yorkshire had been assured that those services would be available following the downgrading of facilities at the Friarage Hospital in Northallerton.
One woman told Mr Lovell: “You don’t know what it feels like to be in labour in an ambulance.” She added that in some parts of the Dales there was no mobile signal so it was quite possible that an ambulance crew would not be able to contact anyone who could advise them if there were complications.
There was also concern that the JCUH was already under pressure with ambulances having to wait in queues until patients were admitted into the hospital. This increased the time that the ambulances were unavailable.
It was reported that in Wensleydale this had led to patients waiting between 20 to 40 minutes for an ambulance. In one case there was a 90 minute wait during which the patient died.
“This is why the air ambulance is so important,” said Gill Collinson, the chief nurse with the Hambleton, Richmondshire and Whitby Clinical Commissioning Group (HRWCCG). She told the meeting that the two new air ambulances would be able to fly at night.
“And that’s why landing lights are needed at the James Cook hospital,” said Burton-cum-Walden parish councillor Jane Ritchie, who is a member of the HRWCCG.
Both Ms Collinson and Mr Lovell said that one of the solutions to the problem of overcrowding at the JCUH was to move planned treatments such as hip and knee surgery to non-A&E hospitals. This would also ensure that such operations were not postponed due to emergency patients requiring surgery.
Friarage Hospital
Ms Collinson discussed some issues in more depth with those of us at her table. She explained that the HRWCCG had initially declined being involved in the discussions about the Better Health Programme because it had just completed a lengthy consultation concerning services at the Friarage Hospital. At that time the HRWCCG was assured that the consultant-led maternity and paediatric services at the DMH would continue.
“If there were now proposals about any changes to the midwifery [and paediatric] services at Darlington we would object,” she said.
“We are trying to bring things back to the Friarage,” she added. Thoracic surgery was now being carried out there, more outpatients were being seen, and more cancer patients were receiving chemotherapy. She said there were experienced physicians at the Friarage who were taking care of patients very well and enabling them to return home quickly. (This is one of the key objectives of the Better Health Programme.)
Local residents emphasised that there was still a problem with ambulance transport even to the Urgent Care Centre (for non-life threatening emergencies) at the Friarage. “We need more ambulances,” said Miss Ritchie.
Everyone agreed with Ms Collinson when she stated that one of the key issues was equity of access no matter how deeply rural a community might be.
Footnote: Mr Lovell said 700 clinical care standards had been collated for the Better Health Programme by doctors in Darlington, County Durham and Tees in accordance with national guidelines. It is interesting to note that not one of those mentions equity of access.
The first two are:
A trained and experienced doctor (ST4 and above or doctor of equivalent competencies) in emergency medicine to be present in the emergency department 24 hours a day, seven days a week.
A consultant in emergency medicine to be scheduled to deliver clinical care in the emergency department for a minimum of 16 hours a day (matched to peak activity), seven days a week. Outside of these 16 hours, a consultant will be on-call and available to attend the hospital for the purposes of senior clinical decision making and patient safety within 30 minutes.
For more information see A&E services in the Upper Dales – a danger alert