Rochdale Infirmary – An open letter to the Health Secretary

Last month the Pennine Acute Hospitals NHS Trust outlined detailed plans of changes to services at Rochdale Infirmary.

Acute patient services, including inpatient paediatrics and maternity, are due to move out in April 2011, whilst services such as day surgery, out-patient clinics and ante-natal clinics will remain.

Last week a decision on whether to cut the maternity unit was deferred until February.

A member of the Infirmary’s A&E team has written an open letter to the Secretary of State for Health Andrew Lansley expressing his concern about the impact that the changes will have.

An open letter to Rt Hon Andrew Lansley CBE, Secretary of State for Health:

The provision of care by the NHS in Manchester and East Lancashire is doomed to fail.

In many ways, looking from the inside, it seems to me that the system is being set up to fail. Whether by neglect or blind stupidity, or by some cynical other agenda, may be a matter of debate; however, as a nurse, I find myself asking time and again “surely they could see this coming”, when we are time and again faced by crises caused by mismanagement of services. I find it difficult to believe that those responsible for hacking away at beds and services are unaware of the consequences of their actions, which leaves the conclusion that they just don’t care.

Not only has Pennine Acute Trust set about diminishing the provision of care for the population of Rochdale, but by impact on the service provision at the other sites, it will diminish the resources available for the people of Oldham, North Manchester and Bury, with a knock on effect for the people of Bolton, Blackburn and the whole of East Lancashire; all of this under the questionable titles of “Healthy Futures” and “Making it Better”.

The devil is in the detail.

If we skirt around the fact the “public consultation” was merely a paper exercise to ensure that the various parties concerned (not the public) got what they wanted, we find that the actions that are being taken now with regard the reconfiguration of services bear little relation to what was agreed at the time.

Even now the statements from Pennine reiterate that 85% of the patients that A&E see now will be seen in the Urgent Care Centre which will be a 24hr operational unit. However, in the reconfiguration that is actually happening, there will be no inpatient provision at Rochdale and radiology will be reduced if it remains at all. It will be impossible to run an Urgent Care Centre with nothing operational behind it. It really does seem that they think they can take us for fools and that we cannot see the consequences that must surely happen – no one with the potential for further investigations is going to be able to be assessed at Rochdale.

Furthermore, having spent years not preparing adequately for the downgrade when it comes to training staff to run the UCC, we now find that everything suddenly has been brought forward to next April. Now, an accountant I am not, but how remarkable it is that this coincides with the end of the tax year, when according to the Chief Executive the trust is not in financial difficulty at all.

At a recent briefing, we were told that there are no plans to demolish the old part of the hospital. Fortunately, the staff within this hospital talk to each other, and if this is true, how come preparation for the demolition has been mooted within the estates department?

Ignorance or lies; does it really matter?

The closure of beds, not only at Rochdale, but at Fairfield too, has been brought on a pace. I know from past experience what the executive thinks about beds–apparently we can do without them as physicians only fill them anyway. The point is, there are not going to be enough beds for the patients we have to care for. If this were not so, those of us in A&E would not be faced with the daily fight to get patients moved on from the department. We would never have to tell an ambulance crew that they were going to have to wait on the corridor. We would never have to “be creative” with times on the tracking system to keep patients’ times within the four hour window (if anyone tells you this does not happen then they are lying).

Team leaders, like myself, are constantly faced with trying to manage unsafe departments. When Rochdale A&E downgrades the pressure is going to mount on the departments that are left, and now that Fairfield is not going to take trauma or surgery, it is going to impact on the other trusts in Bolton and Blackburn. Blackburn has already been under pressure since Burnley A&E downgraded, how on earth is that department supposed to cope with an even greater workload? How long do you think it will be before Fairfield A&E downgrades and piles on even more pressure? The signs are there for anyone to see.

The lack of thought for any of the consequences of moving services is quite often astounding in its sheer idiocy. As an example:

The staff in A&E and the night nurse practitioner discovered during the night of Tuesday 30 November that since surgical services had moved two days earlier there was no medical cover for the remaining patients on Woolstenholme Ward and surgical patients on Springfield Ward. This only came to light when A&E were asked if they could assess a patient in need on Woolstenholme as there was no cover. It then transpired that there was a bleep for medical cover; however, it was still in the Security Office. When the nurse practitioner discussed this with the administrator on call, they had no idea who was supposed to be covering the patients on these wards or what provision, if any, should have been made.

It quite simply beggars belief.

In A&E, now that surgical services have been moved, we are facing increasing waiting times for beds to be allocated, and then when a bed at another site has been found, the patient has to wait even longer for transfer, and all of this without, as yet, a surgical assessment. This can only get worse as more and more demand is placed on an already overstretched ambulance service.

There are other things coming in the not too distant future that are going to impact on the bed capacity that surely someone must have thought about. Some time ago, I pointed out that elderly care had, in effect, been privatised (a point that was not disputed by the Department of Health). Most of the residential homes are owned by big companies whose primary motivator is profit. As the local councils have less money to spend on social care thanks to the cuts, fewer patients will be placed as funding them becomes more difficult. If anyone thinks that any private concern is going to keep homes open when they cannot run them at a profit, then they are frankly delusional. Fewer placements means only one thing: blocked beds. When we cannot find beds adequately as it is, then patients are going to bottleneck in A&E. This will in turn affect the ambulance services capability, as crews queue on corridors waiting to offload patients–those who are waiting at home will just have to wait longer and longer.

NWAS have tried downgrading calls to NHS Direct with the result that a patient with a surgical emergency was downgraded and eventually made their own way, in agony, to A&E. It is only a matter of time before someone dies in their own home just for the lack of transfer to an A&E.

The other day an elderly patient from Littleborough was admitted to Fairfield Hospital. Their infirm spouse was then faced with the choice of paying £40 each way for a taxi, as they could not manage on a bus, or not visiting. She had no choice really; how many journeys would have used up her pension do you think? I think it is the callous disregard for how these decisions are affecting people that is most striking. It seems that no time has been wasted thinking about the consequences for the people who rely on the service.

As an aside, it has been rumoured that in a recent meeting with more senior managers The Executive instructed them not to feel sorry for the staff when telling them they had to redeploy to other sites as they [the management] owe them nothing.

Just the kind of leadership we need.

To amalgamate tertiary services often makes sense. The changes within this area, however, are all about removing basic services such as emergency care. Quite frankly, all this talk of an emergency “super centre” is smoke. The emergency care at Rochdale’s A&E has been tested time and again in increasingly difficult and under resourced circumstances, and has managed at least as well as any other department. Removing it is only going to increase the pressure on Oldham’s A&E; where are the extra resources and capacity for them? It will not matter how super the “super centre” is, when the patients cannot get there in time, and if they do get there, they have to wait on the corridor for hours. The plans to deal with these problems are woefully inadequate, and it will only end in disaster for someone.

But who is it that someone who will ultimately suffer as a result of the reconfiguration and the reduction (make no mistake it is a reduction) of services for this area? Will it be the Pennine Executive? Perhaps those who have made the decisions about “Healthy Futures & Making it Better”?

Of course not, the price for this wholesale axing of services will be ultimately paid by some poor soul who could have been in the right place at the right time, but who instead has been abandoned by those who should really know better.

Yours Sincerely,

Richard Watkins