- Full extent of ‘Beeching-style’ closures of major casualty units that leave millions with huge journeys for emergency care
- Documents reveal ‘urgent care’ centres which will replace them can’t even treat anyone who needs routine pain-relieving drugs
A massive – and until now unreported – programme of closures of accident and emergency departments will leave millions forced to use so-called ‘urgent care centres’ that in reality cannot provide urgent care, a Mail on Sunday investigation has found.
The centres are allowed to handle only the simplest injuries and mild illnesses. An NHS document obtained by this newspaper reveals they are legally forbidden from treating a vast array of serious and life-threatening conditions, including shock, internal bleeding, most types of broken bones, breathing difficulties, stab or gunshot wounds, heart attacks, strokes and head injuries.
Extraordinarily, they are also banned from treating patients suffering from ‘severe pain’ – defined as anybody who needs medications not commonly prescribed by GPs, such as intravenous pain-relief drugs
The A&E closures mean serious diagnostic errors and untreated conditions are likely to become more common. And some patients now face an hour’s journey to reach a full hospital A&E department.
One patient who has already suffered is 23-month-old Emily Laking – who nearly died after being seen at a clinic that replaced her local A&E.
Emily had a raging fever, severe cough, lacked energy and was vomiting. Because the University Hospital of Hartlepool’s A&E had closed 11 months ago, her parents took her to a One Life centre, staffed by nurses and GPs. A doctor there said Emily was simply dehydrated, and prescribed Dioralyte – the chemical-replacement salts normally given to patients with diarrhoea.
But Emily continued to weaken, so the next morning the family made the 30-minute drive to what is now their nearest A&E department, at North Tees Hospital in Stockton.
There, Emily was diagnosed with double pneumonia and a severely enlarged heart.
Her father Neil said: ‘The doctors told us that if we hadn’t ignored One Life’s advice and taken her to A&E, she wouldn’t have made it through another night. She spent 13 days in hospital, mostly in a heart unit, and six months on medication.
‘I’ll never set foot in the One Life centre again. I wouldn’t trust them to put sugar in my coffee.’
The Mail on Sunday’s investigation has found the family’s experience is far from unique – and equally serious errors are likely to become more common in many areas due to cuts in A&E. Patients at urgent care centres who are referred for further treatment at a proper hospital face long journeys, which may take more than an hour in peak traffic.
Supporters of the closure programme are led by Health Secretary Andrew Lansley and NHS chief executive Sir David Nicholson. They claim the switch to bigger and fewer A&Es will improve patient care by focusing emergency treatment in high-tech ‘centres of excellence’.
They say urgent care centres will be enough for patients with minor problems who should not be treated in A&E at all. But critics, including many doctors, say the closures are being rushed through – putting patients’ lives at risk and depriving the affected hospitals of ‘patient intake’. This means they are likely – as has happened in the past – to lose many of their remaining services.
Opponents also argue that the real purpose of the ‘slash and burn’ approach – as it was described by one London hospital consultant – is to save money. The NHS must cut £20 billion from its budget by 2015.
Until our investigation, no one has known the scale of the A&E reform programme. NHS decentralisation, imposed earlier this year means such policies are no longer being driven from Whitehall.
A Department of Health spokeswoman said yesterday: ‘These decisions should be made locally. We don’t know as well as the local health professionals what is needed for the populations they serve.’
She added that closures should only take place when conditions laid down by Mr Lansley had been met: they should be clinically justified, supported by local GPs and patients, and ‘promote patient choice’.
But The Mail on Sunday can reveal that department closures are looming on a scale so large that one doctor likens them to the drastic cuts on the rail network imposed in the Sixties by Richard Beeching, the then British Railways chairman. The hospitals slated for department closures include four in North West London; three elsewhere in the capital; and Trafford General in Greater Manchester
Some plans fly in the face of assurances made by David Cameron before and after he won the 2010 Election. In 2007 he promised a ‘bare-knuckle fight’ to stop A&E and maternity closures, listing several that have now closed or are set to — including Hartlepool, King George Hospital in Ilford, East London, Trafford General, Chase Farm in Enfield, North London and St Cross in Rugby.
He even attended a protest against the plans at Chase Farm, a few days after the election. The hospital’s future was a huge local issue, and thought to be behind the Tories gaining the seat from Labour.
In April last year, Mr Cameron chose another hospital, Ealing, to launch his health reform Bill – now the Health and Social Care Act. He praised the staff’s excellence and said: ‘It’s because I love the NHS so much that I want to change it, because the fact is the NHS needs to change.’ The hospital now faces A&E and maternity closures.
Mr Lansley, too, spoke of the need to continue services at Ealing and Chase Farm before the Election. They were, he said, ‘by any measure … large emergency departments’ and their treatment could not be easily provided elsewhere. He added: ‘If you’re somewhere like Ealing, Ealing Hospital is a very appropriate location … to access services.’
But NHS leaders now say the cuts are essential. Last month, Sir David Nicholson described them as a ‘really, really important set of changes for the NHS as a whole’. He singled out the pending upheaval in North West London as ‘a really good example of people genuinely striving to improve quality and outcomes on the one hand, and keeping costs under control on the other’.
There is evidence that concentrating care for some emergency conditions in fewer, specialist units can improve patients’ chances. Stroke victims, for example, are more likely to recover if treated swiftly by neurologists with clot-busting drugs.
But replacing A&Es altogether has two glaring drawbacks. First, patients who need treatment that urgent care centres can’t provide face long journeys – often after already waiting.
A seasoned paramedic in Northern England said: ‘We’ve all been taught from day one about the “golden hour” – that first 60 minutes after someone is seriously injured or falls ill when the right care is vital. If you go to an urgent care centre before being driven to an A&E, there may well be nothing left of it.’
Such a delay almost killed Julie Rigg, who has a rare condition that means her veins can burst at any time. When a potentially fatal bleed began, she was taken by ambulance to the One Life centre in Hartlepool – which, according to its protocols, had to turn her away. In agony, she then went to North Tees Hospital, where her life-saving treatment did not start for a further 45 minutes.
The other major drawback is the danger that an urgent care centre GP, often a temporary locum, will not have the experience and skills to recognise more serious conditions.
It is believed this factor was behind Emily Laking’s ordeal.
Other examples include Callan Redshaw, 17, who was prescribed paracetamol at the One Life centre after a week of headaches. He collapsed two hours later. He had actually suffered a brain haemorrhage, and needed a five-hour operation.
In another case investigated by The Mail on Sunday, a road accident victim went to an urgent care centre in Kent that failed to spot he’d fractured his neck in two places. The delay in treatment left him permanently disabled and unable to work.
Yesterday, North Tees and Hartlepool NHS trust insisted that thousands of One Life patients had been ‘highly satisfied’ with their treatment. A spokeswoman said: ‘We are continuing to work with all services within the centre to make ongoing improvements and ensure all patients continue to receive high-quality care.’
Where A&E units have not yet been closed, there are mounting concerns about the much-vaunted public ‘consultation’ process.
In Ealing, two weeks after the 14-week ‘consultation’ has begun, the documents on which the closures are based have yet to be printed for the public and local health workers.
More than 60 GPs and hospital consultants in the borough last month held a protest meeting and speaker after speaker argued if the region lost four A&Es, the remainder would not cope. One GP told The Mail on Sunday: ‘Nothing gets me angrier than the claim that these changes are being driven by us. It is being done in our name but I and many others believe the results will be very negative.’
According to the advocates, the remaining A&Es’ extra workload will be mitigated by the urgent care centres and improved ‘community services’ provided by GPs. However, an urgent care centre has been operating in Ealing in tandem with its A&E for two years, and there has been no reduction in ‘grade one’ emergency cases (needing hospital admission). This is despite the centre managing to treat 30 per cent of its patients.
Although A&E closures are being partially driven by the need for budget cuts, Ealing Hospital is also managing its finances very well. Last year it turned a £28,000 surplus, and has met its financial targets for the last six years.
In North West London, however, the nine local hospitals are set to reach a combined £320 million deficit by 2015. Tomorrow, Labour is using one of its Opposition parliamentary days to focus on the NHS crisis. Shadow health secretary Andy Burnham will reveal that NHS spending has been shrinking for the past two years, with almost all of last year’s £1.7 billion underspend being clawed back by the Treasury, a process he wants reversed.
He will also show that nearly 4,000 full-time nursing jobs have gone since the 2010 Election – but spending on expensive agency nurses to fill the gaps has risen by 50 per cent. Mr Burnham said last night: ‘David Cameron made two promises to the country at the last Election: not to cut the NHS, and to fight “bare-knuckle” to keep A&E and maternity units open. He has broken both.
‘He promised to put doctors in the driving seat but has allowed closures to be driven through even where they don’t have clinical support.’
Heart attack, breaks and strokes can’t be treated
Despite often being billed as local A&Es by NHS bosses, the leaked document makes it clear that the ‘urgent care centres’ can handle only the least serious illnesses and injuries.
They can change wound dressings and stitch shallow, but not deep, cuts. They can handle head injuries where there is no sign of concussion or loss of consciousness, minor facial injuries which do not need stitches, fractured collar bones and fingers, and ‘minor medical conditions’ such as ‘sore throats’.
But anything more serious is legally ruled out.
On the ‘urgent care centre exclusion list’ of banned treatments is just about everything for which most patients would normally go to an A&E. Patients will have to travel elsewhere if they suffer heart attacks, strokes, suicidal feelings, drug or alcohol intoxication that may need observation.
The centres are also unable to treat all major traumas from traffic accidents or assaults, all but the simplest fractures, chest pain, kidney stones, drug overdoses, serious burns, suspected meningitis, poisoning, internal abdominal bleeding and penetrating eye injuries.
Anyone who has been referred by their GP for specialist hospital treatment for any condition is excluded, as well as those who are confused, in pain severe enough to need more than over-the-counter medication and any pregnant woman suffering from persistent vomiting.
‘To describe a place with these restrictions as an urgent care centre is a joke,’ one hospital consultant said last night.
Mothers will be sent to unit damned in report
Closing A&E and maternity departments means millions of patients will be forced to use existing facilities which are already under great pressure.
Hundreds of mothers will have to travel to Queen’s Hospital in Romford, East London, when the maternity department closes at King George Hospital in Ilford.
Last year, a damning report by the Care Quality Commission said mothers giving birth at Queen’s maternity unit were ‘at risk’, after two deaths there.