Hospital cuts plan: inefficient, costly and could risk patients’ survival

Speaking as a concerned citizen at yesterday’s Calderdale and Kirklees Joint Health Scrutiny Committee meeting in Halifax Town Hall, retired Eye Surgeon Dr Colin Hutchinson explained that the hospital cuts proposal – to send all planned care patients to Huddersfield and all acute and emergency patients to Calderdale Royal Hospital  – was risky for both patient safety and the long term viability of both planned and acute/emergency services. Here is some information about services that Calderdale Royal Hospital would lose if the proposal goes ahead.

This is Dr Hutchinson’s statement to the 6th April Joint Health Scrutiny Committee:

When I started working in Halifax, in 1995, we were mainly working out of two hospitals. Most of the surgical specialties were based in Royal Halifax Infirmary, and most of the medical specialties in Halifax General Hospital, barely a mile apart. As an Eye Surgeon, if one of my patients was experiencing serious medical problems and I needed help from one of my physician colleagues, it could be a matter of days, and certainly many hours, before they were able to break from their duties and come to the other hospital. It delayed effective treatment and I can well recall feeling very uneasy as to the risk in such situations.

It is now proposed to build separate facilities for “planned care” and “urgent care”, six miles apart. Given the age range of patients having joint replacements and many other kinds of surgery, some of them will develop general medical problems, such as heart attacks, loss of control of their diabetes or any one of many other scenarios. At the moment, it is fairly easy and quick to call on help from an experienced physician. That will no longer be the case.

If a patient (or visitor) has a cardiac arrest at the planned care site, the level of expertise available to the resuscitation team is unlikely to be as high as on the urgent care site, which could affect their chance of survival.

If a patient has, for example, had a gall-bladder removed, and starts to bleed during the night, or at the weekend, and has to return to theatre, will there be the facilities to open and staff an operating theatre at the “planned care” site, or will they have to be put in a blue light ambulance to take them to the urgent care site for treatment? The consultation documents do not tell us, but I suspect that there will not be two theatre teams on stand-by.

Following many kinds of operations, a post-operative review by the operating surgeon, to ensure that the patient is recovering satisfactorily and to deal with any complications that might be occurring, is an important part of patient care. If these patients are in a different hospital from the main part of the surgeon’s workload, there is a significant risk that they will not receive as close post-operative supervision as they now enjoy. It will also make it more difficult to allocate the surgeons’ working time cost-effectively.

There is no clear separation of the support services required for “planned care” and “urgent care”. Diagnostic imaging and other tests are needed for both; catering, cleaning and portering services are needed for both. Splitting the hospitals in the way proposed builds in the need for duplication of facilities and staff that condemns the services to long-term continuing additional costs and inefficient working practices, and the very real threat that they will be non-viable in the longer term.

At the moment, if there is an influx of seriously ill patients to the Trust, beds allocated to “planned care”, are switched to cope with acutely ill patients. This does mean that planned operations can be cancelled at short notice, but the priority must be to deal with acute life-threatening and disabling conditions, and most patients accept this, knowing that next time it could be they that need the bed. Remove 119 beds to a separate site, and that ability to respond flexibly to peaks of demand is lost. The result will be many more days when the hospital will be closed to new admissions, which will have to be diverted to surrounding hospitals.

Back in 1995, we were making do with the legacy of buildings a hundred years old, built in another era and had to do the best we could. Only a fool would build such risks and inefficiencies into a newly designed system, such as that which is being proposed to us today. If the powers that be have decided that we cannot be allowed to have functioning hospitals in each of our towns, at least let us have one that is equipped and staffed to deal safely with all the variable circumstances that arise in both planned and emergency settings; there is too much overlap between these two categories to separate them.

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