NHS chiefs 'do more' to explain changes at Wycombe Hospital
11:49am Thursday 22nd March 2012 in Where I Live
HEALTH chiefs have responded to some of the points raised by the Bucks Free Press last week - after we asked for more evidence to support the planned changes at Wycombe Hospital (see related links).
Dr Graz Luzzi and Dr Geoff Payne wrote:
Following last week’s BFP we felt that we should try to do more to explain the evidence, guidelines and clinical thinking behind the proposals.
The facts are as follows: The most recent College of Emergency Medicine guidelines published in 2010 recommend that each A&E department should develop plans to have ‘at least’ ten consultants to help ensure 24/7 consultant led emergency care. The guidelines provide evidence from a number of hospitals describing the benefits of having sufficient emergency consultants working together on the same site.
The College guidelines state that having the right number of consultants improves patient safety through; consultant-led care, enhanced clinical decision making [in particular leading the resuscitation of the critically ill or injured] and increased supervision of more junior members of the medical team.
The benefits also include reduced numbers of serious untoward incidents, fewer unplanned returns and fewer missed x-rays.
There are currently six consultants working across the two sites. Even if additional consultants could be recruited (and the College guidelines mention the severe shortage of these specialists) they would not see sufficient patients to keep up their skills. This would not be a safe strategy for patient care.
If the A&E consultants form a single team in Stoke Mandeville, as is proposed, then acute medical emergencies brought by ambulance need to be taken to the same site.
Heart attacks and strokes, which are mostly diagnosed out of hospital, require direct access to specialists and specialist equipment to receive life saving treatment as quickly as possible and this will continue at Wycombe Hospital.
This means that the relevant specialist medical physicians and their teams for gastroenterology, diabetes, respiratory and older emergency inpatients need to be centralised at Stoke Mandeville as well.
This will also bring the benefit of ensuring these consultants can spend more time with their patients. The consequences of reduced consultant cover were set out in the recent Dr Foster report which showed increased mortality rates at weekends when fewer senior doctors are on duty.
Furthermore, evidence from Addenbrookes Hospital in Cambridge shows increased survival rates when emergency consultants and these specialist physicians work closely together in a single unit.
Another important advantage is that treating these patients at the hospital which also provides emergency surgery means that people do not need to be transferred by ambulance between hospitals if this is required.
In 2006 the Royal College of Surgeons stated that treating undiagnosed emergency medical patients without having emergency surgery available was not good practice, giving the example of what might happen to a patient with a gastrointestinal haemorrhage (e.g. a bleeding stomach ulcer) in a hospital that lacks emergency surgery, as is the case currently with Wycombe.
The Royal College of Surgeons also stated that the minimum population base to support a sustainable A&E department was 300,000. The population served by Wycombe Hospital’s emergency medical centre falls far short of this and even taking account of any increases in the birth rate will remain so for many years.
We understand that the proposals seem complex but hope that people will accept that they are based on sound evidence and good practice, and that the hospital doctors and GPs who developed the proposals believe they will be the safest and most sustainable option for patients.
The BFP raised the point that with just six A&E consultants, the new A&E department at Stoke Mandeville would still not meet the College of Emergency Medicine Guidelines.
A spokesman for the NHS Cluster said the guidelines provide an ‘ideal’ number of consultants which hospitals should try to reach.
She added: "Putting the six consultants together on one site, and together with the lead medical consultants for diabetes, respiratory, gastroenterology and older people’s services, has to be a much better option than have them split across two sites. The model was reviewed by the National Clinical Advisory Team and given their approval."