Sunday, December 21, 2014

Not letting A&E be a casualty

IT'S some years now since I was taken ill at the end of  a day  at work, and when the symptoms persisted after I got home, knowing my GP's surgery would be shut, I rang NHS Direct. The nurse who called back advised me to take a cab right away to the nearest hospital A&E.

Living at the time quite near Park Royal, or Central Midddlesex, hospital, I did not bother calling for a cab, but walked over to the A&E where after some time in a busy, crowded and noisy waiting area (so bad the overworked and stressed receptionist could not hear me properly, so any record will show a visit by someone with a similar but differently spelled name to mine), I was seen to, and kept in under observation. After three night's rest which I turned into a week off work I was pronounced well enough, and am here to tell the tale.

A friend whose initially similar symptoms, misdiagnosed as "just a bug" by his GP,  turned out to be something more serious, ended up dying after treatment in the same hospital, a year or two before my short stay. But that is a different story, though it explains why I got the wind up when taken ill.

 The A&E and much else at Central Middlesex has changed beyond recognition since my brief stay. There's a bright new entrance, a bigger, more comfortable waiting area, and better facilities, and the hospital as a whole seems to have grown, with new buildings partly paid for if I'm not mistaken by a so-called Private Finance Initiative (PFI). 

Unfortunately, these things come at a price. If I still lived nearby I'd no longer be able to stroll up the road to be seen there, nor can my former neighbours rush down with their kids when they are injured, nor anyone who has an accident in Park Royal's many workplaces. Even the new bus station handily placed outside the hospital entrance is not much use now. You won't have to wait in a queue at the Central Middlesex A&E anymore, because after cutting back on its services, the health authority has - as people predicted - shut it altogether.  The same thing has happened to Hammersmith hospital too.

As was also predicted -  though not by the authority and experts, it seems - not only are people from Willesden and Acton facing greater difficulty and a longer journey reaching the alternative - Northwick Park hospital in Harrow -but the staff at Northwick Park A&E, which we were told could provide a better service, are having difficulty coping with the increased workload. So wherever you live the result is longer waiting times, more stressed staff, and - as is happening elsewhere -ambulances kept waiting to discharge patients, when they could be going on their next call.

Patients in west London have the longest wait for A&E treatment in the country following the closure of two casualty units.

Each week hundreds wait for longer than the NHS target of four hours, as pressure has soared at the three nearest hospitals.
Critics say axing the casualty units at Hammersmith and Central Middlesex on September 10 has put other hospitals under “unbearable pressure”, with patient care suffering as a result.
Figures from NHS England reveal the trust that runs Northwick Park and Ealing hospitals was the worst in the country for A&E performance in the final two weeks of October.

So much for the promise of "centres of excellence" created by concentrating facilities at one site.

Ealing hospital was only saved incidentally after massive demonstrations by local people, and some outspoken health professionals, with support from the council as well.  Where people were slower to wake up and mobilise, the cuts have gone full steam ahead.

Some people in the health service, and in the media of course, seem to think it is their responsibility to make excuses for government and blame the public when things go wrong. So we were told that reducing casualty services to one site would be better for us. Delays in ambulances reaching calls are supposedly explained by people making frivolous calls (though in my experience ambulances are not sent out to anyone who asks, just like that); not to the government reducing the number of ambulance stations, nor to ambulances having to queue to discharge patients at hospitals.
And see:

The other day I saw some jobsworth on TV explaining that the reasons Northwick Park was having difficulty seeing patients in time was that once people know an A&E facility is there they will use it.
Maybe if I were more cynical I'd suspect the idea had been to move the service away from the more centrally placed and accessible Central Middlesex hospital, hoping enough people had no idea where Northwick Park was or how to get there, and a lot of them would not make it.

A couple of years ago, having heard a revealing talk from Dr.John Lister of London Health Emergency about what was happening to the NHS, Brent Trades Union Council of which I am a member decided to commission a report from him, with the aim of alerting people to what was threatened in north-west London. With help from Ealing and other trades councils this was published as a news-sheet.

Though the Central Middlesex A&E has closed, the fight is not yet over. This week I received a press statement from the Brent borough council;

Independent commission to review A&E closures in West London
2 December 2014

An independent commission, chaired by leading barrister, Michael Mansfield QC, is being set up by Brent Council along with three other local councils in west London, who have been deeply concerned by deteriorating local hospital services.

The closures of hospital A&E services in West London have been followed by lengthening waiting times for residents struggling to get seen at over-burdened neighbouring hospitals. With the expected imminent spike in demand from winter pressures, fears are rising that lives are being put at risk.

Growing disquiet at the knock-on effect on other hospitals, of the closure of emergency services at Central Middlesex and Hammersmith, has also resulted in the surprise announcement by NHS England of its own inquiry into how hospital reconfiguration in west London is being handled. The councils remain concerned about the impact of closing further services at Ealing and Charing Cross hospitals on the remaining emergency services in the region.

Official NHS figures show the trusts that run St Mary's, Charing Cross, West Middlesex, Ealing and Northwick Park hospitals have all failed to meet A&E waiting time targets over recent weeks.

In the three weeks after 19 October, all three hospital trusts dipped below the national target, which says 95% of patients should be seen within 4 hours. Performance at North West London Hospitals Trust, which runs Ealing and Northwick Park hospitals, fell to just 67.8% of patients being seen within 4 hours, the second worst result in the country.

Now, Brent Council along with Hammersmith & Fulham, Ealing, and Hounslow have got together to set up an impartial inquiry to look in depth at the impact local closures are having, and at the implications of further hospital reorganisation proposals, including the planned closure of services at Ealing Hospital and Charing Cross Hospital in Hammersmith.

As well as reviewing the evidence provided by the NHS to support their reorganisation, the commission will be asking others to contribute evidence. It will also commission further research to fill the gaps in existing evidence.

Councillor Muhammed Butt, leader of Brent Council, said: "Our worst fears, about the effects of closing local A&Es before the expansion of Northwick Park was complete, have come true. Brent residents now face the longest A&E waiting times in the country and immediate action needs to be taken to resolve this situation as we are talking about life and death emergency treatment. Further delays to the A&E improvements at Northwick Park will only make the problem worse. West Londoners deserve the best healthcare and this joint review will be vital in shining a light on what has gone on with these botched A&E closures."

Last week, hospital bosses faced tough questions from Councillors at Brent Council's Scrutiny Committee who decided to keep the matter under review.

Michael Mansfield QC last year chaired the Lewisham People's Commission, an inquiry into the proposals to close services at Lewisham Hospital. He has represented defendants in criminal trials, appeals and inquiries in some of the most controversial legal cases in the country. He represented the family of Jean Charles de Menezes and the families of victims at the Bloody Sunday Inquiry. He chaired an inquiry into the shoot to kill policy in the North of Ireland and has represented many families at inquests, including the Marchioness disaster and the Lockerbie bombing. He also represents the family of Stephen Lawrence.

Weekly A&E figures supplied by NHS England…/ae-w…/weekly-ae-sitreps-2014-15/
Statistics » Weekly A&E SitReps 2014-15
The Weekly A&E collection collects the total number of attendances in the week for all A&E types, including Minor Injury Units and Walk-in Centres, and of these, the number discharged, admitted or transferred...|By Statistics

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