Grantham A&E – Answers to questions presented at ULHT trust board on 6 September by Cllr Ray Wootten

Answers to questions presented at ULHT trust board on 6 September by Cllr Ray Wootten about Grantham A&E.

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Grantham A&E questions answered:

1. How many patients have been taken to other hospitals in an emergency whilst Grantham has been closed overnight and is this considered safe?

As you are aware, Grantham people with the most life threatening conditions are already taken by ambulance to Lincoln, Pilgrim or Nottingham. Paramedic staff are highly skilled in their decision making, provision of immediate treatment where clinically appropriate and where required resuscitating patients until they get to an appropriate place for further care.

In making the very difficult decision, we discussed the potential impact on EMAS with their senior team. The impact across a range of measures, based upon ULHT data, has been lower than we expected.

On average, based upon ULHT information, two more people are being taken to Lincoln County Hospital from a Grantham postcode via 999 ambulance each evening, than before the changes came into effect.

2. Will the ambulance service receive additional funding as its operatives are naturally going to be deployed for longer as they will have to travel further, and by how much and, will they be able to meet the “door to needle time” in the event of a stroke and cardiac emergencies?

ULHT doesn’t fund or commission ambulance services. EMAS is commissioned by Hardwick CCG and is a question for them to consider.

The agreed protocol between ULHT, EMAS and GP is patients with suspected acute strokes or cardiac emergencies are taken by ambulance to Lincoln (for hearts and strokes) and Pilgrim (for strokes). 999 and EMAS prioritise patients based on greatest need to ensure those with serious or life threatening conditions are seen first.

In the case of heart attacks, the national target from the time that an ambulance is called until support by a cardiologist using primary percutaneous coronary intervention is less than 150 minutes. Lincolnshire Heart Centre not only meets this target but performs better than the national average against this target.

For some time, patients with suspected strokes, acutely unwell children, and people who need emergency surgery have been taken by ambulance to Lincoln and Pilgrim A&Es, and they have better outcomes.

In Lincoln and Pilgrim A&E, staff maintain the expert skill levels required to treat these patients. The injured and ill are treated by the right clinicians, in the right hospitals, as quickly as possible. These patients receive more rapid care from staff who can identify life-threatening injuries and illness much quicker, access key tests such as CT scans faster and perform life-saving operations and give life-saving treatments earlier

3. Can the A&E departments to which patients are being sent cope with this extra pressure given that ULHT cannot meet its A&E waiting times?

Before its closure, between 6:30pm and 9am Grantham received on average 31 attendances. Of these, 25 self-presented and six arrived by ambulance.

So far early indications suggest that the expected impact on demand and waiting times in Lincoln and Pilgrim A&Es has been lower than expected. Lincoln are admitting 1 more patient from a Grantham postcode a day and 4 more people from Grantham postcode are going to Lincoln over a 24 hour period of which 2 are arriving by ambulance

However, it has had a positive impact on being able to staff rotas, with 1 in 6 rotas at Lincoln now being staffed by Grantham middle grades.

4. Has account been taken of laying on additional patient transport for Grantham patients when they’re discharged from hospital?

Over the next few months, ULHT will be going out talking to ULHT members and community groups about Grantham A&E to understand how the changes may be adversely affecting patients. We will be discussing our findings with local commissioners to reduce impacts where possible.

5. How are you monitoring that lives have not been lost due to the fact that patients are being transported to Lincoln or elsewhere instead of Grantham?

We are working closely with EMAS to understand the impact the change of opening hours is having on them, their staff and patients.

6. You hold locality forums which are attended on average by a dozen or so members of the public. These according to your website are designed to listen to the public who have an interest in shaping how NHS services are developed locally. With this in mind, do you not think that 19,000 residents who have signed a petition to ask for A&E to be reopened and 7,000 online comments are a clear message that the board have got it wrong by closing A&E overnight?

It wasn’t an easy decision to reduce the opening hours of Grantham A&E but it was the right decision to protect patients and maintain safe services across Lincolnshire. ULHT is committed to fully reopening A&E as soon as we have enough doctors but we cannot compromise on safety to deliver convenient services.

Everyone has a voice. We want to hear from as many people as possible. The NHS belongs to all of use, and we encourage as many people to join the ULHT membership scheme as possible.

Our quarterly locality forum meetings, held across Lincolnshire, provide an opportunity to members of the public to take part in consultation and engagement in developing services from the patient perspective. Details about these forums can be found here Establishment of Locality Forums.

7. Grantham hospital sign states that it is an A&E. Before this closure it was led by a consultant 24/7 so why does the board persist in calling it is level 3 when it is clearly level 1. Do you not need to consult if you change its status?

Before its closure, Grantham A&E wasn’t staffed by consultants 24/7. ULHT employs two consultants in the A&E at Grantham, both of whom are locums and not permanent members of staff. Their working hours were and remain 9am to 5pm Monday to Friday. Outside of these hours, there is off-site on call only.

According to NHS England definitions, Grantham A&E is a level 3 A&E and not a level 1. (see https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/03/AE-Attendances-Emergency-Definitions-v2.0-Final.pdf)

NHS England’s definition of a level 1, which demonstrates that this does not apply to Grantham A&E is as follows:

“Type 1 A&E department = A consultant led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients”.

NHS England’s definition of a level 3 A&E is as follows:
“Type 3 A&E department / Type 4 A&E department / Urgent Care Centre =
Other type of A&E/minor injury units (MIUs)/Walk in Centres (WiCs)/Urgent Care Centre, primarily designed for the receiving of accident and emergency patients. A type 3 department may be doctor led or nurse led. It may be co-located with a major A&E or sited in the community. A defining characteristic of a service qualifying as a type 3 department is that it treats at least minor injuries and illnesses (sprains for example) and can be routinely accessed without appointment. An appointment based service (for example an outpatient clinic) or one mainly or entirely accessed via telephone or other referral (for example most out of hours services), or a dedicated primary care service (such as GP practice or GP-led health centre) is not a type 3 A&E service even though it may treat a number of patients with minor illness or injury”.

8. In 2015/16 there were 4,500 999 ambulance admissions at Grantham, how are you coping with the increased transport to other hospitals?
See answer above for question 1.

9. Residents complain it takes 4 weeks to see their local GP, so how can you say that patients should not attend A&E when clearly they need emergency treatment as nothing else is available locally?

If people do need to see a GP urgently between the hours of 6.30pm and 9am, GP out of hours service is available on the site of Grantham hospital. It is by appointment only via calling NHS 111.

Although waits to see a GP in hours can often be longer than ideal, A&Es aren’t the best place to treat ongoing or chronic conditions. For example as A&E doctors don’t have access to a patient’s GP medical record, this doesn’t help support these types of conditions. A&E staff are highly trained and experienced in treating emergency, or acute, or very serious conditions, not routine coughs and colds.

10. How many patients in 2015/16 attended and were admitted to Grantham’s HDU with non-invasive ventilatory support and how many had sepsis?

Between 1 April 2015 and 31 March 2016, 54 patients were admitted to Grantham’s HDU with non-invasive ventilator support and 61 were admitted with sepsis.

11. The Prince of William of Gloucester Barracks state that soldiers are having to be taken elsewhere for treatment after suffering injuries whilst training due to the closure of A&E. This is time consuming and costly for our armed forces who like local residents need care and attention immediately when they are injured or fall ill and deserve to be seen locally.

We have been in touch with the regimental adjutant at the barracks. They told us the impact so far has been minimal and that the two personnel who have been injured have been treated at near-by urgent care centre in Newark. As you may be aware, this facility is expected to close within the next two years.

Visit the following page for more frequently asked questions about Grantham A&E –https://www.ulh.nhs.uk/news/lincolnshires-aes-at-crisis-point-frequently-asked-questions.