In his latest blog post, Mid & South Essex STP medical director for hospital programme Dr Ronan Fenton’s proposals for the planned transfer of anything up to 40 seriously ill patients a day between Southend, Basildon and Broomfield hospital under the latest STP are extremely scant on detail.
He talks of an “additional type of hospital transport service alongside the ambulance service”, whilst failing to acknowledge that the East of England Ambulance itself has a severe staffing crisis with anything up to 100 vacancies unable to be filled. Where is he suddenly going to produce all these highly skilled people from? In the late ’90s nearly every ambulance would have two qualified paramedics on board; today you will find only a single paramedic on 60% of ambulances and none on the rest.
By his own admission, patients in transit will need specialist care and monitoring during their transfer “at least as good as the referring hospital”. With the chronic shortage of trained nurses and consultants we have been experiencing for years now in our hospitals, where is he going to find the medical staff to travel back and forwards across Essex 40 times a day?
There is no disputing that patients with multiple and serious injuries should be taken to a Major Trauma Centre – this has unequivocal support throughout the medical profession. The same goes for patients suffering STEMI heart attacks being transferred to Basildon’s cardiothoracic centre – however this averages only around two patients a week from Southend. My concern is with the lack of local engagement with clinicians on the drafting of these new plans. At the recent public meeting organised by Save Southend NHS, the lead clinician of Southend A&E, Dr Caroline Howard, stated that some of the proposals were “the most dangerous I’ve ever seen”.
The STP’s remit is to cut spending on the NHS by up to £500 million in Mid & South Essex by 2021. I have yet to see any figures that show how this idea is going to contribute to the £90 million annual budget reduction for our three hospitals or, much more importantly, any evidence that patient care will not suffer.
We have recently seen irrefutable evidence that the former Success Regime, now STP, is not adverse to twisting the facts and rationing detail to suit its narrative. We are about to be swamped by more fairytale press releases from the STP alongside glossy brochures from their PR department, full of smiling patients, flashy graphics and charts showing how we can all look forward to a brighter, healthier tomorrow for a fraction of the cost.
I think most of the public are wise enough to know that if it looks too good to be true, it probably is.
Dr Fenton’s blog post and article in the Southend Echo (28/12/17) – I reply here as it appears comments are disabled on Dr Fenton’s blog
Beyond boundaries – transferring patients to the care they need By Dr Ronan Fenton
The way we care for people in hospital has changed enormously in the 31 years I have been a doctor.
As techniques and indeed technology have improved we have been able to develop much more specialist care, where complex and severe conditions are treated by those at the very top of their skill.
As a consultant anesthetist over my career I have worked alongside colleagues in numerous specialist units where we can better manage illnesses and injuries that were previously untreatable, left people with severe life changing needs or just did not survive.
In specialist services, advances in medicine bring new and ever higher standards that rely on teams of specialists being available round the clock. Currently, it is not always possible to ensure a full team of specialists is available 24 hours a day at all three sites. Not because of money but because of shortages in specialist doctors and nurses across the country.
In the consultation proposals we are describing how our hospitals could work together in the future. We want to build on what we do well now, developing highly specialist units across the three hospitals to ensure we can provide these services to achieve the very best quality of care and outcomes for those small numbers of patients who would benefit the most.
The skills needed to do this are already here in our teams.
Right now, today, in Essex some of the most critically ill patients in our region are transferred from their nearest hospital to get them to the highly expert care they need at another hospital.
For most people this level of care is thankfully not something they will experience very often, if at all, but it can be reassuring to know that professional teams are used to managing patients across organisations, geographical boundaries and networks of care to get them to the care they need, when they need it.
For example in mid and south Essex we link into two major trauma networks – East of England and North East London – where patients are transported to major trauma centres outside of the county.
Major trauma describes serious injuries that are life changing and could result in death or serious disability, including head injuries, severe wounds and multiple fractures.
These major trauma centres are staffed by consultant-led teams that meet the patient on arrival and have immediate access to diagnostic and treatment facilities.
This doesn’t mean the care at the local hospitals is any less than it should be – but that the expertise in that strand of medicine is concentrated in one place to ensure it is always available and the best most up-to-date procedures are used.
The Essex Cardiothoracic Centre at Basildon is another first rate example of this on our own doorstep and has for the past 10 years received heart patients from across our county by emergency transfer.
I am also privileged to support and witness the work of the Essex and Herts Air Ambulance a vital charity which supports the transfer of critically sick patients across the region by helicopter or ambulance alongside the East of England Ambulance Service.
Working regularly with both these services I see on a weekly basis the issues involved in transferring critically ill patients. It takes planning and precision across multiple teams in partnership with the patient and their relatives. It requires full clinical assessments of the risks and benefits to each individual and the right equipment to ensure safe transfer.
Each transfer has to be managed depending on the nature of the underlying illness, level of dependency and risk of deterioration during transfer. But we do it very successfully now.
In all of the examples I have described patient well-being is the clear priority for the medical team in making the decision to move someone to the most appropriate place to continue their treatment.
The safe transfer of any critically ill person requires the standard of care and monitoring during the transfer to be at least as good as that of the referring hospital, and that the outcome of the care they receive as a result of being moved is better.
In our proposals we describe the ambition to introduce an additional type of hospital clinical transport, alongside the ambulance services that we already commission from the East of England Ambulance Service.
As the clinical lead for this initiative I am talking to experts in our region and beyond to further develop this but also crucial to how we design this service is what you think.
Our aim is to improve clinical care but we also recognise there may be concerns for some people in having to travel further than their local hospital. So during the consultation period I would urge you to take the time to feedback to us and help us develop our plans in partnership.