Forum Topic

A&E

This week at Northwick Park Hospital Data for London North West Healthcare NHS Trust63.9% Patients seen in 4 hours.Second worst performance in the country.

Graham Weeks ● 4273d33 Comments

Voted Tory all my lifeTheir approach to Ealing, NW London and the country as a whole for A&E is a disgrace and they won't see my vote againI'm all for NHS reform, cutting out waste, improving efficiency etc but shutting down A&E Depts and increasing fast response admission times cannot be the way forward. It would take a magician and a very good hypnotist to convince me different!!

Colin Goodman ● 4273d

Colin,The current changes aren't a new policy - they are actually part of the NW London reconfiguration that was designed and enacted in the last Parliament under a Labour Secretary of State for Health.When Labour sit on the sidelines saying they will "fight" the changes the inconvenient truth is that when in office they designed them AND sought to enact them.  The likes of labour candidate Rupa Huq are either disingenuous or simply ignorant of these facts when they say they have always defended the NHS - this is even more ridiculous given the performance of the NHS in Wales where the Labour has actually cut the budget by 10% so far and the performance for A&E wait times is dramatically worse than in England.Shutting down small A&E departments (particularly those that under perform) is exactly what's required and an approach you'll find in most of the health systems that perform better than ours e.g. Netherlands, Germany, and precisely why the changes were designed in the first place / based on extremely detailed analysis and as part of a long term ambition of both Tories and Labour to move more healthcare delivery into primary care.The changes to A&E configuration is driven by two things:1. More of the day to day work historically done as "critical" care by A&E departments is now managed as "urgent" due to improvements in response times, technology and reductions in road accident casualties etc. Shorter length of stays also means that bed utilisation is lower for admissions.2. More conditions can be managed entirely in Primary care provided that the funding is made available - at present secondary care consumes the majority of the NHS budget.3. More complex / genuinely critical admissions to A&E require specialist skillsets and infrastructure that just can't be provided in every hospital - both for efficiency reasons and the need for specialist clinicians to work regularly enough in teams to hone their skills. A good example of this is the removal of stroke services from local hospitals - although every politician at the time were telling the public this would lead to a disaster it's actually led to more patients surviving, less patients requiring ongoing rehab and social care AND saved money in the process - what the public is told to expect by politicians and the actual outcome are often diametrically opposed.If primary care worked properly the pressure on A&E would be alleviated very quickly. Throwing more resources at A&E won't fix the real root cause or improve the experience of NHS care of the population as a whole.

Ed Yelland ● 4273d

I'm no expert but if an A&E is 8 minutes from my front door and it gets shutdown and the nearest one is then 22 minutes then in anyone's spin or language that is introducing at best inconvenience or at worst increased risk of death / serious illness!!!I'm aware of Labours stance and the withdrawal of my vote would be for all these self preserving charlatans. I'd sooner vote for an independent or the Monster Raving Loony Party

Colin Goodman ● 4273d

Colin, an extra 14 minute journey might be inconvenient but its unlikely to be dangerous given that even critical cases can be stabilised for journey times of up to 30 mins (or longer).The 14 minute extra convenience for occasional hospital visits needs to be put into context though - ealing hospital gobbles up close to £200m a year. Spreading the load across other hospitals would likely increase the quality of care and outcomes and release badly needed funds to transform the primary care services that are required on a daily basis.

Ed Yelland ● 4273d

Ed answer me this succinctly and honestlyIf, after being taken seriously ill by accident, collapse etc, you had the choice between an 8 or 22 minute journey to further expert care, equipment, bloods and drugs, which one would you opt for?Please don't spin about depends which hospital had the most specific care, what your condition is etc, etc. I'm talking about getting to a crash team either by ambulance OR driven by Joe Public

Colin Goodman ● 4273d

Colin, my honest answer is that whether the journey was 8 or 22 minutes to A&E in an ambulance it would be unlikely to make any real difference to my survival chances in a genuine emergency.The range of diagnostic / treatment technology on today's ambulances is dramatically different to even 10 years ago - it's this improvement that has enabled all emergency stroke cases in London to be sent to only 8 hospitals with the outcome that despite the longer journey time 96 fewer patients die each year - in short we already know that going to St Mary's instead of Ealing for emergency treatment providing that the Ambulance despatch time is acceptable.http://www.bmj.com/content/349/bmj.g4757There's also another good example from the uk. In rural areas that don't have a choice of 5 hospitals all within a 15 minute drive e.g parts of derbyshire, cornwall, cumbria etc. the clinical data shows that mortality is no different for many emergency cases (heart attack, stroke etc) than for urban areas.The travel time issue is a perfect example of perception not being supported by the facts - and in this case our preference for ongoing access to one of the countries worst hospitals (ealing) in favour of a slightly longer journey time to another hospital not only means more patients are dying, it also means the associated financial flows will never reach primary care in order to reduce the need for so many emergency admissions in the first place... a good example of this being cancer where the UK is one of the worst performers for appropriate referrals from primary care (as measured by the % of cases first diagnosed in an emergency setting).

Ed Yelland ● 4273d

I don't like the way the NHS is treated by the main political parties.  I wish the NHS was the one and only truly apolitical organisation which operates without any political influence or bias placed upon it.

Gerry Tan ● 4273d

Gerry, you may want the NHS to be the nation's sacred cow but the reality is it is the nation's bottom;less pit, loved by all.

Graham Weeks ● 4273d

Ed - I don't know if you are in politics or not; if you aren't then you certainly should be as you have that innate politicians ability not to give a direct answer to a direct question.I asked for your preference in journey times and I was expecting an answer in the manner and vein given. In fairness my question is a hi-jack as there can be only one sensible succinct answer - ie the shorter travel timeOf course the other thing your view and statistics (and we all know that expression about statistics don't we?!) fail to take into account is ambulance dispatch times. A couple of months ago I had the misfortune of going back to Ealing Hospital, a place I know and detest, for my final follow up appointment. I counted SIX ambulances on the ramp with cases actually waiting inside them to get into A&E. That's 6 less ambulances available for 999 calls for however long. Back in March last year I was extremely fortunate that a rapid response paramedic was parked around the corner on her break when my missus had to ring 999 for me, a full on ambulance crew arrived within 12 minutes (still a long time considering it was 2.00am, a Tuesday and my closeness to both Ealing Hospital and Hanwell Ambulance Station). The staff were first class but on arrival at A&E it was shambolic With unmotivated staff nurses, too few doctors, filthy conditions and a complete lack of care or morale - therein lays the issue. The systems and management of A&E departments needs sorting out!! I don't think you achieve this by shutting them down as you'll merely be focusing the problem in bigger centres!! I'm sure you'll argue this is the whole reason behind changes being required but as a simple layman it just doesn't stack up for me.The NHS has been failing as a system for decades and I agree it is getting used and abused where it most certainly shouldn't be. I don't have all the answers, far from it, but what I do know is shutting down key frontline services in an already massively over-stretched system is NOT the answerI'll say no more

Colin Goodman ● 4273d

Colin, a direct answer to your question would be rather churlish because the premise behind your question i.e. shorter journeys are better / longer journey times are unsafe is simply not true. I've given evidence to support my view so other than your personal preference and belief, there's nothing to support your view. You could take it to an extreme - maybe we should all have maximum 1 minute journey times and a hospital at the end of every road but in reality a balance needs to be struck that reduces risk to patients in genuine emergencies / critical care episodes whilst enabling the NHS to be affordable. For that reason I genuinely don't care if I'm in an ambulance 8 or 22 minutes providing that it reaches me quickly, I start to receive care as soon as the ambulance arrives, my condition is stable for the duration of the journey, the place I'm taken to has fantastic clinical outcomes / staff who routinely manage the condition I'm taken in with i.e. they do it frequently enough to give a repeatable clinical outcome.

Ed Yelland ● 4273d

A couple  more things to throw into the mix:Ed Miliaband on record in an interview with Nick Robinson stated he wanted to "weaponise" the NHS. Presumably in lieu of any labour policy the only thing he has left is to scare the country into voting Labour over the 95% of patients seen within 4 hours despite comparator wait times in other"good" health systems being:* The State of Victoria has 75%* Ontario has 90% of patients with minor conditions (complex they have 8 hours to deal with)* Stockholm has 71-79%* Netherlands and Germany have no guideline on this.Prof Mike Richards (former national cancer czar) is also quoted as saying that simply spending more is almost never the solution to improving NHS care - what's required is getting the process, mindset and behaviour of staff right and focussed on the patient.If Prof Mike Richards as a world leading Clinician doesn't think the current problems can be solved by more money alone, what are we to make of the pledges by Labour to throw even more money at a system that's long over due for significant reform.. ?

Ed Yelland ● 4272d

I am all for, and respect, what the NHS does to serve and treat the residents of this country.  But I am not sure why it should be virtually exempt from the financial constraints that other areas of Government expenditure are under.  Surely the primary role of the Government is to offer security to its citizens against both internal and external threats?  With savage cuts to both police and armed forces in an increasingly unstable world I think the balance is wrong. No point looking towards a healthy and lengthy retirement when your world is turned upside down by outside aggressors.

Philip Coe ● 4272d

For the sake of your own sanity give it a rest Ed. If I want a selection of miscellaneous vaguely health related "facts" from around the world to quote out of context I can easily Google them for myself. None of them can disguise the current steeply falling performance of A&E services locally and it is still blindingly obvious that closing A&Es without providing any alternative primary care facilities while at the same time cutting spending on social care is not the solution.

Paul Conlan ● 4271d

Our NHS should not be treated as something political parties score points with - its the nations precious and vital possession - leave it alone.

Gerry Tan ● 4271d

Some thoughts Philip about your post and those that preceded it. The Shaping a Healthier Future plan to close 4 A&Es and 3 hospitals in our area could have been designed by anyone. It was however Andrew Lansley MP who approved, launched and promoted it. Remember it was he who brought in the top-down reorganization that David Cameron promised would never happen.At this election the NHS will be a political football. That is because one group want to pass it carefully towards the goal of the best care for all and the other want to kick it into space lose the ball and replace it with the US system.For the electorate the choice could not be clearer.We are a rich nation. There is money for the NHS, for police and for the forces. All we have to do is get much, much better at setting and collecting taxes

Arthur Breens ● 4270d

Living with someone who works in the NHS in West London, I'm continually staggered by their firsthand stories of financial waste and operational inefficiencies. For example, there's a massive over reliance on temporary contractors who get paid a premium over permanent staff. Due to what seems a complete absence of proper performance management, the permanent staff then sit around photocopying while temp contractors pick up the bulk of case loads with minimal induction or oversight. Poor organisational culture and management incompetency is rife in the NHS, but unfortunately the facile 'national treasure' cliche and persistent political posturing doesn't allow an honest debate and practical solutions. More cash won't solve the real problems.

Andrew Benfield ● 4265d

"Poor organisational culture and management incompetency is rife in the NHS..."Unfortunately, most large organisations have many incompetencies and operational inefficiencies - and you can't get bigger than the NHS. Thank goodness these weaknesses and inefficiencies aren't prevalent in the operation theatres and surgical clinics of our hospitals.

Gerry Tan ● 4265d

I too live with someone working for NHS, won't disagree there would be savings to be made however find your statement bit of a generalisation.Partner is nursing on the wards where staffing levels have never been lower, amount of text messages we get in morning and evening looking to work bank shifts (cover) in worrying and when not filled agencies provide at extra costs.We do need to spend more on training, recruitment and I am willing to pay more in tax for it.

D Downey ● 4265d

I think it's going to be difficult to train and recruit more doctors and nurses while the working conditions are so stressful: classic vicious circle. Most doctors say that their pay is acceptable but their work-life balance intolerable.

Susan Kelly ● 4265d

I believe that we should train many more nurse practioners to take the routine work load off GPs, thus leaving GPs to treat fewer complex cases. The nurse practioners could always refer complex cases to the GPs.

Gerry Tan ● 4265d

Ooops a typing error - that should be practitioners.

Gerry Tan ● 4265d

Arthur, with respect you seem to have missed the rather essential point that the "Shaping the Future" strategy was actually developed by PCTs and NHS London. NHS London was led by Ruth Carnall and under the stewardship of Sir David Nicholson - both Ruth and David have always been  staunch Labour supporters.Andrew Lansley had no hand in the development of the strategy other than final decision rights over something that NHS Managers and Clinicians analysed in significant detail over 2 years. People often overlook the significant involvement of Clinicians in analysis and plans to change the provision of services.We may not like the analysis that underpins "Shaping a Healthier Future" but given none of us were part of the work that was done it's pretty poor to criticise it carte blanche.

Ed Yelland ● 4265d

Colin,The thrust of medical thought in recent years has been to move to larger centres of excellence.  This is what underpinned Labour's Darzi Review which led to centralising of stroke centres. Very successfully as it happens.  You talk about journey times.  The fact is that major traumas, ie bad car injuries, gunshot, etc, have gone straight to St Mary's for years now.  They drive you past all the local A&Es.  St Mary's has a 24/7 rota of trauma consultants.  They can save you.  Everyone else will just send you to St Mary's.  You get better outcomes for patients by doing this.  That is the theory anyway.  The Royal College of Emergency medicine reckons you need a catchment area of about 500,000 to make a proper, grown up A&E viable.  That is why Shaping a Healthier Future envisaged 4 A&Es for 2 million people.  In Ealing we hated that all the A&Es near us were ear-marked for closure leaving a us the hole in the donut whilst there was a ring of four A&Es around us.  The Secretary of State, Jeremy Hunt has intervened and saved Ealing and Charing Cross so we have 6 now and most people in our borough remain relatively near an A&E.  The re-org could have been much better done.  It is just dumb that they didn't open the new £21 million A&E at Northwick Park before they closed Hammersmith and Central Middlesex A&Es.  All this stuff is hard.  It probably hasn't been done as well as we would like.  Labour is trying to make a political football out of the NHS but is refuses to actually say what it would do differently.  The answer is that not much would have been different in this five year Parliament and not much will be different in the next.  The NHS has big challenges to face and its staff need to get on with it.  The politicians shroud waving doesn't really help them or inform anyone.

Phil Taylor ● 4264d

Arthur,Your posting is inaccurate as you well know.  Shaping a Healthier Future (SaHF) is merely the local roll out of the £20 billion Nicholson Challenge that was on page 4:3 of the 2010 Labour manifesto.  Nicholson was kicked off by Andy Burnham in 2009 and his failure to acknowledge it as his own child shows what a complete worm the man is.  Nicholson was well established by May 2010 and the idea that the Coalition would ditch it in the face of the financial crisis at that time is just ridiculous.  The SaHF documents specifically reference Nicholson as a starting point. SaHF builds on the philosophy of Labour's Darzi Review and is a natural consequence of long running changes in medicine and the way the NHS responds to them.  The Lansley changes are relatively trivial compared to the vast impact of Nicholson.  I would challenge the local NHS to do a better job as would you.  Pretending it is all the Tories' fault is just nonsense.  On your point about taxes you are plain wrong.  This country typically collects 35% of GDP in taxes and has not exceeded 37.6% since 1963.  http://www.theguardian.com/news/datablog/2010/apr/25/tax-receipts-1963It is easy for Socialists to say tax more but in practice in this country we can't.  To fix the NHS by throwing cash at it you need to take 5-10% out of everyone's pay packets to pay for other people's health care.  That isn't going to happen.

Phil Taylor ● 4264d

"one group want to pass it carefully towards the goal of the best care for all"Would that be the same "group" under whose watch it is estimated 400-1200 patients died due to poor care at Stafford Hospital, whilst the hospital was meeting all its official targets, and then refused to hold an independent public enquiry into what went wrong?

Vlod Barchuk ● 4264d

Ed,Sorry but Lansley was the captain of the ship. If Shafting a Healthier Future was dangerous and on board he should have jettisoned it when he set sail. No point in having a government if it keeps looking back blaming other people and doing nothing. I was part of the pre-consultation discussions.Then the SaHF team were unable to answer even simple questions (mine)round the table and the clinician(GP Brent) on my table could barely contain his anger at the proposals at this formative stage.And Ed it was McKinsey that produced this plan and not clinicians. McK talked to clinicians but never came back with proposals at the formative stage. The clinicians  I have knowledge of seem very worried. Please see Private Eye 1326 because their experts were worried too.My summary was that this was an estate management job. Ealing police did a similar one...sell the good for housing profit sites and move to a hanger in Park Royal. So we know what we were looking at.

Arthur Breens ● 4257d

6 January at Northwick Park Hospital Data for London North West Healthcare NHS Trust 63.9% Patients seen in 4 hours.Second worst performance in the country. 6 February 71.2% seen within 4 hours. Improvement but still the second worst in England.

Graham Weeks ● 4242d

"My summary was that this was an estate management job. Ealing police did a similar one...sell the good for housing profit sites and move to a hanger in Park Royal. So we know what we were looking at."Your summary has no more evidence to it than the article in the Sunday Sport a few years backon the London Bus "stuck" on the moon. Just because you believe something to be true (without any evidence to support your assertion) doesn't make it so.

Ed Yelland ● 4242d

The police have had the Alperton operational base for years.I recall taking my son there to the Traffic Division open days over twenty years ago.It makes sense to see this asset extended and used to its full potential.

Nigel Brooks ● 4242d

The point is though that it is and always be political. Politics is not an abstract concept, it is about how we run our country.You say leave it alone, do you mean give it no more funding, do you mean ask no questions about how it spends it's funding, do you mean give it whatever funding it wants? All of those could be what you mean.It is and always be a political issue, because it is funded and run by the government (well, funded by us, but with money taken by the government) and politics is sort of how we choose the people in that government.

Nick Goodliffe ● 4242d

And this from the man who dried up when asked about the constitution of the McKinsey team.

Arthur Breens ● 4242d

This was for Ed Nigel got it in the wrong place..silly old duffer.

Arthur Breens ● 4242d

Cheers Arthur, I was confused myself there for a minute :-)

Nigel Brooks ● 4242d