Friday, 29 July 2016

Chorley A&E closure - Poor management? or a hidden agenda?

Campaigners hopes of the A&E at Chorley reopening were dashed this week with the Lancashire Teaching Hospitals NHS foundation Trust stating they STILL didn't have enough doctors to reopen the emergency department.

Many believe the closure of  the A&E at Chorley and South Ribble Hospital was 'engineered' and the ultimate goal is for the Trust to replace the A&E with a 24-hour Urgent Care Centre early next year.

The Care Quality Commission (CQC) have rated the Lancashire Teaching Hospitals NHS foundation Trust as 'requiring improvement' across both its hospital sites (Preston and Chorley).

As such, the Trust have had penalties placed on them and have fixed targets to meet. The trust are also being closely monitored by both the CQC and Monitor (the body who oversees Hospital foundation trusts).

Because of this close scrutiny, be very aware that this hospital trust will not take any risks in case they lose their 'foundation' trust status, oh and they won't want to open the A&E at Chorley until they have a full complement of doctors, even though last week they were only one doctor short and they could have re-opened using a locum whilst continuing with their recruitment campaign, or so it is said.

The quickest way to smooth out their finances and remove themselves from the grips of the CQC and Monitor is for the Hospital trust to replace the A&E at Chorley with a less expensive, less surgically intensive, lower risk 'urgent care centre'. 

But they wouldn't do that would they? Have a read below, then YOU decide....

A hospital A&E or 'Emergency Department' is the most expensive service a Trust provides. It costs millions per year to run and is very high risk for both patients and hospital trust. Many hospitals have replaced their A&E departments with much the less-expensive urgent care centres. This enables the Trust to settle their finances, pay off any outstanding debts, and improve the ratings and penalties imposed upon the trust by the CQC and MONITOR.

The System Resilience Group (SRG) was established in response to the A&E crisis at Chorley hospital due to a shortage of staff. The 'crises' has been ongoing for years, but since MONITOR and the CQC got involved the issue became public and the trust seem to have panicked, and in due course it set up  the SRG group... the rest is very scary reading....

The SRG includes health and social care organisations in central Lancashire and is responsible for ensuring the urgent care service is working.  The SRG group has been meeting weekly to review the situation at Chorley & Sth Ribble hospital to ensure patient safety is not compromised.

Hence, the SRG is basically a collection of representatives from the CCG, lancashire care, NWAS, and of course the trust; so far no members of the public have attended any of the meetings...

Did you know that since 13th July, Lancashire Teaching Hospitals NHS foundation Trust stopped receiving any new CVs for middle grade doctors? the sourcing continues through agencies...
... in April 2016 the SRG was reminded that permanent consultants in the [Chorley] emergency department had been covering the gaps over the last THREE years! [source: SRG meeting minutes April 2016]

This means the staff recruitment process for the Chorley A&E department should have started in 2013.

The trust spent almost £1 million to build a new urgent care centre at the side of the A&E at Chorley & South Ribble hospital. At the same time, it was paying consultants £375,000 per year in overtime to cover the A&E rota gaps to prop up the flagging A&E.

Before the Trust can reopen the A&E at Chorley, it needs to make a recommendation in relation to what it considers to be a safe, sustainable service level which the SRG, in turn, would need to consider and indicate its support. The A&E at Chorley can't reopen without agreement from the SRG.

Several times at the SRG meetings it was mentioned that unlike most other trusts, Lancashire teaching hospitals NHS foundation Trust still have 'two' A&E's; a rare and exceptionally financially challeging position when compared to other organisations. This is the first indication of replacing the A&E at Chorley with an urgent care centre.

In 2014 The Care Quality Commission gave an overall inspection report rating for the trust as ‘requiring improvement’ for failing to provide safe and responsive services.  Ironically, Karen Partington, Chief Executive of Lancashire Teaching Hospitals NHS Foundation Trust said, “Overall the CQC inspection reports are very positive about the way our hospitals are run, and the quality of care we provide".

At a Trust Management team meeting in July the trust board stated " there has been little effect on other A&E services because of the closure of our A&E [Chorley] . The minutes from the meeting however paint a different picture saying "Mr G Curry reported on significant pressures that had been seen during the previous weekend at Royal Preston Hospital’s emergency department with a high number of breaches. It was noted that ambulance turnaround times had been affected with ten ambulances backed up on Saturday".

At an SRG meeting in July [2016] medical director of the trust Professor M Pugh asked when it was expected that the 24-hour urgent care centre (UCC) would be opened at Chorley and Mr M Gaunt confirmed that the result of the preferred supplier would be known in August, there would be a 3-month mobilisation period and the intention was to open the Chorley and Preston urgent care centre in January 2017.

It was suggested the trust make a bid via the CCG to run the UCC but the 'preferred' supplier would be open to a private venture. This appears to be the first indication that a 24 hour privately run urgent care centre would replace Chorley A&E in January 2017.A strategy seems to be unravelling of stalling recruitment of A&E doctors to justify safety issues and replace the A&E with a 24 hour Urgent Care Centre in January 2017.

At the same meeting in July, several 'models' were discussed, one of them being to close the A&E at Chorley and replace it with a 24 hour urgent care centre. A temporary decision made in April was to close the A&E and replace it with a 12 hour urgent care centre, with a view to revisiting the other models later.

In May this year, a whistle blower reported the trust to the Care Quality Commission (CQC) with allegations relating to increased  activity at Preston owing to closure of the Chorley emergency department; insufficient staffing levels within Ward 19 (previously the medical assessment unit) and the
emergency decision unit; safety concerns within EDU and the surgical assessment unit (SAU); and allegations regarding the death of a patient.

During the first TWO weekends in July, Lancaster hospital [emergency department] sent requests to the Lancashire Teaching Hopsital NHS foundation trust that ambulance services from Chorley do not transport patients into the Lancaster hospital area. source: pg 6 SRg report july 2016


Saturday, 9 July 2016

Chorley A&E closure was no accident

Before we look at what's happening at Chorley & South Ribble Hospital, a little history of how downgrading an A&E devastates communities..

In November 2007 the East Lancashire Hospital NHS Trust closed Burnley hospital's A&E department and moved it to the Royal Blackburn Hospital. The reason for this 'centralisation' was apparently to implement a two-tier A&E service, with specialist expertise in areas such as stroke and trauma concentrated in fewer hospitals. Another excuse used to close local A&E's was that a large percent of patients attending A&E only required minor treatment.

People were told that by centralising A&E's doctors would have a higher case load with a greater variety of cases which would enhance their skills and contribute to their continual professional development.

It turned out to be one big political farce that ended in disaster.
The centralisation model was based on an old danish model where 'urgent care centres' sat side by side in the same building as its A&E,so less urgent cases would free up Emergency cases.

In England however, the separation of Emergency care (A&E's) from 'elective' (pre-planned) care resulted in A&E's being moved many miles apart and replaced with nothing more than plaster posts called urgent care centres (aka minor injuries units).

So who decided to close the Burnley A&E? and what did people say about it?

I'll be brief here:  The people and councils of Burnley, Pendle and Rossendale objected to the move so the decision went to the Lancashire county health overview & scrutiny board meeting at county hall in Preston. At the time, the centralisation plans were a Labour government idea originated by Ari Darzi (a rectal surgeon) and governmental health advisor, and supported by Andy Burnham, the Health secretary at that time.

The proposal was made at the meeting and was passed by a small Labour minority of county councillors under guidance from the Labour health minister. The Burnley MP kitty usher was told that if a decision wasn't made at the meeting there would be financial penalties. That turned out to be lies.

The resulting closure of Burnley's A&E and move to Blackburn was devastating. Considering the Trust already had an almost ONE BILLION POUND interest bill on their Private Finance Initiative (PFI), the effect on patient care at Blackburn Hospital cannot be underestimated.

Patients left lying in their own faeces for hours, pensioners sent home with drip needles still in their arm, ambulances queuing with patients in the back for hours on end, understaffed, over-capacity...
Eventually the Blackburn hospital had to close its doors sending ambulances to other hospitals in Lancashire. Ultimately, Sir Bruce Keogh and the CQC decided the hospital Trust be placed in special measures.

So How does this relate to Chorley & South Ribble Hospital?

The 'centralisation' mantra has been used many times to enable a hospital trust to minimise finances and risks. This is especially true for 'foundation trust' hospitals who are free to tender for private services and spend money in areas they deem more profitable (esp. to reduce PFI interest).

In 2010, the Lancashire Teaching Hospitals NHS Foundation Trust (LTH NHS), responsible for A&E's in Chorley and Preston, encountered problems in acute services. A shortage of permanent qualified emergency doctors at the trust led to the trust employing agency staff along with temporary (locum) doctors to fill the ED rotas. The main rota however was to utilise existing permanent ED doctors and rotate them to fill the gaps. A very risky plan but nonetheless would work as long as the doctors and agency staff were available, and their were no increases in A&E attendances. This would result in serious patient safety issues.

In early 2016 doctors were locked in a long dispute with the tory government over a proposed change to junior doctors contracts. The Lancashire trust lost 1 doctor and at the same time the government implemented a 'cap' on hospital trust spending on Agency staff.  LTH NHS trust had gambled that a national shortage of doctors would excuse them from any responsibility if scrutiny found out.

In Early April 2016 the trust made a decision to close the A&E at Chorley and utilise more locums to form an urgent care centre so as to reduce risk to patients.  Previous board papers however suggest the plan to downgrade was in the pipeline earlier.

A trust group was set up to monitor how the downgrade at Chorley might cope without an A&E.
Whilst the Trust had no PFI debt they had an overcast projected debt of around £1m as of May 2016.

Financially, in June 2016 the trust appealed to Monitor, the body who oversees NHS foundation trusts, for more finance. Monitor replied by giving the Lancashire trust time to meet certain standards and get their house in order.

Chorley A&E closure was no accident, the trust responsible had ample time between 2010 and 2012 to recruit enough doctors to cover the rotas at BOTH Preston and Chorley hospitals (10 permanent + 4 locum across BOTH sites).  It's a miracle the trust blagged it  for so long, likely due to a failure by Health scrutiny committees accepting overload was the norm.

Reading the Trusts historical board papers, it doesn't take a genius to see why this trust failed to retain the A&E at Chorley.

The question now remains of how fast can the trust recruit the doctors needed to re-open the A&E at Chorley by August as they claim.

Well, they've had 5 years to resolve this and they've still given no guarantee it will happen

Of course NOW the trust are in the spotlight they must PROVE to the PUBLIC WHY they lack the infrastructure, and if they step out of line, we will know. We are all watching,,,,,,