A&E Services in the Upper Dales – a danger alert

In July 2016 North Yorkshire County Councillor John Blackie issued a health warning for the Upper Dales. He, and many others in the Dales, believe  there is a serious threat to the emergency services at the Darlington Memorial Hospital (DMH) due to a consultation being carried out by the NHS in Darlington, Durham and Tees entitled “Better Health Programme”. (Scroll down for report on the public meeting at Hawes in August when this was discussed.)

The loss of 24/7 full scale A&E services at the DMH, including the consultant-led maternity, paediatrics and children’s services there, could mean that people living in Hawes would have a 60 mile journey for emergency care.  Cllr Blackie has provided the following information:

SOME FREQUENTLY ASKED QUESTIONS (FAQs)

Where will the nearest hospital to Hawes be for emergency care if the DMH loses these Emergency Services ?

To be decided but most likely at the James Cook University Hospital (JCUH) or University Hospital of North Durham (UHND), both 60 – yes SIXTY – miles away from Hawes.

Weren’t we promised by the local NHS when 24/7 Consultant-led maternity / paediatric services were closed at the Friarage Hospital in Northallerton that  they would be available at the DMH, no further than the Friarage from Hawes ?

Yes

So this was a hollow promise, wasn’t it ?

Please make your own mind up. I know what I think.

Doesn’t the Friarage have a 24 / 7 A&E service ?

Yes but in name only as it has been run down by the local NHS to what is called an Urgent Care Centre. Emergency ambulances from the Upper Dales head for the DMH, bypassing the Friarage, and the local NHS has publically stated that children under the age of 16 will not be seen at the Friarage but sent to the DMH (!) or the James Cook UH.

So isn’t it important that the DMH retains its A&E service, it is a very long way to the JCUH or Durham if you have had an accident, an emergency healthcare event, or one of your young children are very unwell, or your partner, daughter or grand daughter are having complications giving birth?

Yes, retaining these emergency services at the DMH is hugely important to us here in the Upper Dales.

The JCUH, an excellent hospital for complex healthcare treatments, is now at full stretch for A&E and maternity. If the DMH and the North Tees Hospital lose their emergency services, won’t it become overwhelmed by the demand ?

Yes, this has already happened when mothers-to-be booked at the JCUH were sent to the Friarage.

We would all lose out then, and there could be very long queues at the JCUH formed by those existing patients needing emergency care services and the new patients diverted by the closures ?

Yes

And this is what they call the Better Health Programme, are they joking ?

Yes this is what the local NHS tell us it is all about. And No, they are not joking.

When did all this start ?

In January 2016 but we in North Yorkshire are only just being consulted now, and only after I prompted the County Council to demand a seat on the Joint Scrutiny Committee of 5 local Councils challenging the Better Health Programme, given that we in the Upper Dales rely on the DMH for these services to save our lives, or the lives of our loved ones.

What can we do about it ?

Spare two hours of your time to attend a Better Health Programme consultation at The Fountain Hotel, on Monday August 1st between 6.00 pm and 8.00 pm. There is no need to book a place – please just turn up on the night. And let the BHP promoters know what you think of their proposals.

This news is so bad I simply do not believe it.

THE WORKING ASSUMPTIONS OF THE BETTER HEALTH PROGRAMME:

  • Balancing clinical standards, better outcomes and workforce requirements means emergency care for adults and children should be provided from fewer sites.
  • James Cook University Hospital to remain the designated major trauma centre for Darlington, Durham and Tees.
  • Key clinical services provided alongside ach other to provide comprehensive emergency services for adults and children.
  • Consultant-led maternity based in the emergency hospitals, to manage high risk deliveries. Midwife-led care for low risk deliveries provided at other hospitals.

POSSIBLE SOLUTIONS ACCORDING TO THE BETTER HEALTH PROGRAMME:

  • Status quo – James Cook UH as major trauma and heart attack centre and three other specialist emergency hospitals: Darlington Memorial, North Tees (Stockton), and University Hospital of North Durham (UHND)
  • James Cook UH and two out of Darlington Memorial, North Tees and UHND
  • James Cook UH and one of Darlington Memorial, North Tees and UHND as emergency hospitals.
  • Bishop Auckland and Hartlepool and one other hospital out of Darlington Memorial, North Tees and UHDN as planned care centres. The additional planned care centre would be at a local hospital with an integrated urgent care service.

CLLR BLACKIE: THE STORY SO FAR – A SAD CASE OF NORTH YORKSHIRE BEING COMPLETELY OVERLOOKED BY THE LOCAL NHS:

The Better Health programme (BHP) started in January 2016 and there have already been two sets of consultation meetings but North Yorkshire was not included in the venues where these were staged.

I was very concerned to read for the first time in May about the BHP, and that the threats to the DMH had not reached the MP for Darlington. Dr Mike Brooks from the top-rated Reeth GP Surgery attending a meeting I was chairing at this time, and he also had not heard of the BHP.

I asked a Question at the May meeting of North Yorkshire County Council (see below), and demanded we at the County Council were given a seat alongside the five other local authorities already appointed to scrutinise the proposals for change. This demand was taken on board, and there are three County Councillors now on this Scrutiny Committee, including myself representing all those in Richmondshire District who use the DMH or the JCUH. County Councillors representing communities using the DMH and the JCUH strongly support retaining the Emergency services at the DMH, as does unanimously all Councillors at Richmondshire District Council.

Now that we in North Yorkshire have forced ourselves onto the scene – rightly so given that all of Richmondshire and most of North Hambleton rely on the Emergency Services under threat at the DMH, and are frequent users of them all, and we are all along especially with communities in the Whitby area already making very extensive use of these Emergency Services at the James Cook University Hospital in Middlesbrough, where they are under pressure now and might be overwhelmed in the event of the proposals for closures at the other hospitals mentioned in the BHP presentation being implemented – suddenly we are being given our first consultation meetings, here on Monday August 1st at The Fountain Hotel in Hawes (6.00 pm – 8.00 pm) and at the same times at the Catterick Leisure Centre on Wednesday August 3rd.

Unbelievably the Chief Officer and Senior Management at Hambleton, Richmondshire and Whitby Clinical Commissioning Group, representing 21 local GP Practices and part of the local NHS, chose not to take a full part in the NHS Officers / Medical Practitioners group on the BHP because it had just completed the review of 24/7 consultant-led maternity and children’s services at the Friarage, and did not think it was necessary to take part in this new review. This decision is highly questionable as the Friarage review removed the very services at the hospital which are now under threat at the DMH, on the grounds they were available at the DMH !

My contact details are shown below if you wish to get in contact with me. The Joint Scrutiny Committee is meeting every two weeks and please be assured it is now hearing loud and clear the voice and concerns of all of us living here in the Upper Dales. Please help me to ensure these essential Emergency services remain available at the Darlington Memorial Hospital by attending the meeting on Monday August 1st between 6.00 pm – 8.00 pm at The Fountain Hotel in Hawes. You do not need to book – just please turn up and let the BHP know what you think of their “Current thinking” and “Possible solutions”.

Question to Cllr Carl Les, leader of North Yorkshire County Council, on May 18:

“The review of Critical Care services, including Accident & Emergency and Consultant-led maternity and paediatrics services at the Darlington Memorial Hospital (DMH) is causing great concern in the Upper Dales.  If these services were cut then communities I represent could be 60 miles or more away from potentially life-saving healthcare provision or a complex birth of a baby.  Some of these services were removed from The Friarage Hospital on the assurance they would be available at the DMH, this despite the deep concerns of 4,000 local residents who marched from County Hall 4 years ago in May in an well-conducted but eventually unsuccessful campaign, fully supported by NYCC, to try to save them.

“Consultation with the public on the review by the NHS has been a low-key back-door affair with none of the events being properly advertised.  I note the Scrutiny of Health Committee is monitoring the situation closely but I do not believe that is a sufficiently robust response to the serious threats posed to both residents of Richmondshire and Hambleton who are increasingly extensive healthcare customers and in-patients at the DMH.

“I (Cllr Blackie) ask for the Leader’s assurance that there will be engagement by him and his Executive at a higher political level, including with leading members of Darlington Borough Council,  who are alarmed at the potential for the dismantling of immediate, urgent & unplanned healthcare services at the DMH their communities depend upon as much as we do here in N. Yorkshire”.

 

“BETTER HEALTH PROGRAMME” PUBLIC MEETING AT HAWES AUGUST 2016

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.

 

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