Monday, 2 July 2012

Intuitively Burnley's A&E closure is bad

I have just watched the Sunday Politics again (see previous blog entry) and it is the NHS Confederation  that is telling us that more A&Es should be closed because we need to spend the money on specialised services. So Burnley A&E was closed because the Trust did not want to duplicate services in both Burnley and Blackburn.

Rineke Schram, the Medical Director of the East Lancashire Hospitals NHS Trust was interviewed and started by telling us that "we haven't been as honest as we could be..." Was she about to tell us that their decision to close an A&E was wrong? Far from it. What she meant by "honest" was she hadn't got enough information out about how right they were to close Burnley's A&E. At least the BBC reporter got it right when she said that the closure was a PR disaster for the Trust.

Rineke makes the case that heart attacks can be treated "quite well" but you  have to pay for this specialised service which is associated with Blackburn's A&E. Unfortunately this unit is not much use if you die from your heart attack or if you die in the thirty minutes or more that it takes you to get to a more distant casualty. One member of the public commented that he would not like to be in the ambulance that got stuck on the motorway.

It is important to strive for improvement in patient services including the outcome for the victims of heart attacks but this should not be done at the expense of a valued A&E service. The Duke of Edinburgh knows exactly what I mean and so does Gordon Birtwistle, Burnley's MP. He reckons that 95% of emergency treatments could be dealt with in Burnley and that was my gut feeling in the last blog. It seems so logical. We know that many routine and common procedures do not need expensive adjoining units. We know that we want a local routine service.

Rineke added that her Trust meets its targets. Well it is obvious that the Trust has no target of keeping a local casualty and if you don't have the target then it won't be measured, but I can tell her that a local service is wanted.

Mike Farrar, the Chief Executive of the NHS Confederation tells us that there has been an improvement of up to 20% of people surviving heart attacks because of the specialised unit in Blackburn. Well I am not sure what this statistic means. 1% is up to 20% so does he mean 1 or 20? What does "up to 20%" mean?

I would question Mike's use of statistics because he goes on to tell us that it is 7 miles from the Burnley to the Blackburn hospital. I have checked the AA Route Planner (have a go yourself) and it tells me it is 16.2 miles! Even allowing for air ambulance it isn't seven. Mike asks a rhetorical question as to whether we would agree with travelling an extra seven miles if we thought we had a 20% better chance of survival? Well I bet that statistically you are much more likely to need a service other than a specialised cardiac service. I don't understand either of Mike's figures anyway. The presenter, Arif Ansari asked him where the 20% comes from and he "thinks" it is Trust information. Is that the same Trust that needs to be honest with us?

Councillor Geoff Driver felt that it was just a false perception that told the people of Burnley that they were worse off because their unit had closed. He said they may even be fearful of this closure so "we have to convince them that it is better so what we have to do is keep monitoring". Let me explain that monitoring may not give him the results that he wants and if the expectations of the people of Burnley were monitored then Geoff would certainly not get the results that he wanted.

Burnley people aren't just intuitively feeling that closure is bad. They know that a visit from a relative will be much more difficult. Not everyone has a car and bus services are bound to make life a lot more difficult for relatives and friends. You don't need intuition to tell you this, but Geoff says "we've got to keep convincing them that they've got a better service". You're right there Geoff.

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  1. The people who are making these decisions can't really understand the dynamics of the area covered, or they wouldn't make the closures...Then again, the tendancy is for more chiefs than Indians these days....and very few "tribe" members. So what else can we expect? Slash a couple of chiefs from the equation and maybe the A & E depts can stay open?

  2. Wouldn't it be nice if it were that easy. I'm also afraid that simple treatments are not appreciated and everything has to be high tech. The good news is that each new piece of technology will need a new manager or three and they can all persuade us about the validity of their case.

    I was thinking about how you get 20% improvements in survival rates. Let's say 50% die before getting to hospital and 50% of the survivors are saved by 'normal' casualties. This means there is a 10% improvement (not 20%)with a specialised unit. Then let's say the extra 30 minutes causes an extra 10% to die. It's amazing what you can do with stats but this would mean there is no benefit for the people of Burnley.