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.
[…] 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 […]
Dr Fenton – the difference for the patient groups you mention ( trauma etc) is that there is ACTUAL MEDICAL EVIDENCE that the longer transfer to specialist care does improve patient outcomes for these groups. The centralisation of these services ( already long established) was driven by that evidence and NOT cost cutting.
The new patient groups for who you are proposing to centralise care DO NOT have the supporting clinical evidence for centralisation and the STP proposed changes are purely driven by potential budget savings ( although even this has yet to be demonstrated anywhere in the contradictory costings detailed in the PCBC). Please also do not try to sell the ‘ambitious’ new transport service as a new revolutionary development – you’ve only invented this because your plans to impose a blanket redirection for all 999 emergency ambulances to the ‘super A&E’ at Basildon were thwarted thanks to mass public, media and MP pressure. You’ve not evidenced anywhere in any document that you’ve costed it, found a provider to run it or sourced any of the highly skilled staff required to run a service which will be required to move the estimated 454 acutely unwell patients per month between the three hospitals. Duplicity is becoming a common theme with any of your plans.
I am baffled by much of Dr Fenton’s article. If we take just one part – the transportation of seriously ill patients from, say, Southend to Basildon. The current ambulance service is missing it’s own targets, day after day, week after week. Yet nowhere in tne STP documents is there any costing to provide the new transport service or to staff it. Our hospitals are all understaffed and cannot recruit enough qualified staff now. So when will we see the figures and detailed transport plans?
I have gone on many transfers to Basildon Royal London and Broomfield hospitals. It can take a long time to travel on our very congested roads even on a blue light and if the patient deteriorates on route its impossible to give adequate and life saving treatnent without shopping as I’m sure uou would know if as an anaesthetist you would know
This plan for all your protestations is financially driven abd will end up as a last minute put together plan which certainly will not benefit the local Southend population. To make this work the A127 and A130 would need to be widened with and all manner of infrastructures put in place which would take years. Also how do you expect elderly frail relatives to get to Basildon or Broomfield as many do not drive i dont think giving Arriva contract would help it just would subject frail elderly worried relatives to an ardous journey that is nit necessary. We do transfer patients to Basildon and Royal London but generally they are first stabilised in Southend to achieve the best outcome. However once patient has been transferred the transferring team have to wait for a taxi to come from Southend to collect them and all the equipment, as Ambulances are needed elsewhere so one wonders where are all these extra ambulances and staff that will be up and down the 127 or 130 it can only result in emergencies and 999 calls having to wait for posdibly critical minuted or hours. We cannot recruit nurses Drs Paramedics and Ambulance personnell at present. I and many of my colleagues firmly belueve you will be putting lives at risk at worse abd a poor outcome at best.
However I guess you will be ready to defend yourself in court if someone dies or has life limiting injuries due to delays in treatment caused by this ill thought out plan, or more likely you would have moved on to your next money saving scheme elsewhere.
Can I ask Dr Fenton, where is he going to recruit all the specialist clinical staff from, to man this so called transport service he envisages? We have a shortage now within the hospitals. Will it be put out to private tender such as virgin or arriva with staff on zero hours contracts? Or will our trusted east of England ambulance service get the contract? Because they have loads of paramedics that can be spared to staff it, NOT!
Given today’s (January 24) coverage in the Southend Echo and the Council’s lukewarm response to many parts of the STP, what action will the STP leaders now take to address the Council’s concerns?
Which figure is correct that has been quoted by your representatives in the last 10 days regards the numbers that will require transfer between hospitals under the new proposals? Is it 15 or 25? How can we trust any of your predicted figures when you are not consistent yourselves?
Can you provide a breakdown of which hospitals those transfers will be between and for which ailments as you surely must have that information to hand to be able to make any guesstimates??
When making assumptions in your transport transfer plans. Can you please answer the following questions;
1. Can you please explain what is meant by Local Authority subsidised Transport use?
2. If this means you expect the LA to put money towards transport, can you please name which elected representatives you have had discussions with on this matter?
3. What response have you had?
4. And if any – what financial commitment has been guaranteed and by whom?
or confirm that this assumption is no longer viable?
Have you taken into account the proposed changes/improvements to the A127/A130 interchange. These plans are well advanced and will take to about 2022-2024 to complete. During that time there will be massive hold ups. How are you looking at getting around this problem? – using the air ambulance which is not funded by government but by public donations.
Why are the transport proposals to the detriment of patients using Southend hospital. The STP figures show 1 or 2 transferring from either Basildon or Broomfield hospital yet you expect 4-5 times more to have to transfer from Southend hospital to either of the others.
Lastly Southend hospital has an award winning stroke unit. Surely it makes sense, if you must have only 1 hyper-acute stroke service, to site it at the hospital which is leading in stroke care. Oh, I forgot, that would mean more Broomfield patients being inconvenienced.