The difference between the public pronouncements of politicians and Sustainability and Transformation Plan (STP) leaders on the NHS and the dreadful circumstances on the ground could not have been more starkly made than over the last few weeks.
At the end of February, Jeremy Hunt received ‘a humanitarian award’ at the World Patient Safety Summit for his global leadership on patient safety. This award is made to leaders who are considered to have made a significant contribution to eliminating preventable patient deaths.
Yesterday Public Matters were asked for comment by the BBC in Hereford & Worcester on letters which had been passed to them revealing serious concerns that had been raised by West Midlands Ambulance Service. The letters are addressed to the CEO of the Worcester Acute Hospitals NHS Trust and show that there have been repeated warnings from the ambulance service to the acute hospitals about the handover time when ambulances arrive at A&E.
The warnings have escalated in severity and on the 17 February Mark Docherty, Director of Clinical Commissioning and Service Development at the Ambulance Trust, wrote:
‘We provide as much support as we can, but I believe the current situation is such a risk to patient safety that you need to take immediate and radical action to protect patients now; we will also need to consider whether referral to the CQC is warranted.’
He also said they were prepared to set up field hospital tents if there was no urgent improvement to the situation.
The hospital at the centre of these concerns is the Worcestershire Royal Infirmary, which hit the headlines in January 2017 when three of its patients died, one after a 36-hour trolley wait, whilst others were reported to have waited up to 54 hours. These events triggered the British Red Cross to call what was going on in the NHS a ‘humanitarian crisis’.
At the time Robin Walker, Conservative MP for Worcester, said : ‘lengthy delays at accident and emergency were “unacceptable”, and (he) would be meeting Health Secretary Jeremy Hunt on Monday. But he said a “significant expansion” of A&E was needed as it is now serving the whole of Worcestershire when it was built in the 1990s to just cater for people living in Worcester.’
“What I really want to make sure is, that we get the new management that have been brought in to run the trust working with the government to deliver that on the shortest possible timescale.”
The new management has taken over the Acute Trust but the letters still make shocking reading. The Ambulance Trust have put together a table of the average and maximum times that it has taken to transfer patients from the ambulances across the West Midlands, where they serve 23 different hospitals.
In the letter of 14 February Mark Docherty says he has been writing since May 2017 expressing concerns about ambulances waiting excessive amounts of time to hand over their patients at hospitals in the West Midlands area. He refers specifically to the previous day when ambulance staff had cared for 17 patients in the hospital corridors of Worcestershire Royal for a combined time of nearly 30 hours.
The table below shows exactly how bad those handover times are. The transfers should take place within 15 minutes. However, the figures show that in November 2017 no hospital served by the West Midlands Ambulance Trust achieved that target with 11 of them taking over an hour. In January 2018 all non-urgent operations were postponed in line with NHS England directives yet the figures for February 2018 show a marked deterioration with 13 of the hospitals now exceeding one hour and the Worcestershire Royal reaching over four hours. The Ambulance Trust calculated that for November over 2000 hours had been spent queueing outside the hospital which delayed them responding to over 1000 patients.
Mark Docherty describes this as: “a critical point where patients are now at significant risk of harm on a daily basis.”
BBC staff we spoke to yesterday told us that at a health scrutiny meeting earlier this week the CEO of the Worcestershire Royal, Michelle McKay, had been asked for the hospital’s response. She is reported to have said that she ‘regretted’ what had happened and that it was ‘unfortunate’ and that they were looking at preparing better plans for next year’s winter crisis. She is part of the new management that was put in place to deal with the severity of the crisis last year.
Apart from the fact that her response shows a disregard for the urgency and immediacy of the situation at the Worcestershire Royal, Michelle McKay seems to have a strange idea of what constitutes winter. Mark Docherty makes it clear in his correspondence that he has raised the issue not only with her but with NHS England and NHS Improvement since last year including a letter in May. This cannot be construed as winter. The severity of the situation has meanwhile escalated.
Research published in the BMJ in November 2017 found that a combination of inadequate spending on the NHS and the drop in nurse numbers since 2010 had contributed to 120,000 unexpected deaths. But the BMA warned that if the situation didn’t change there could be as many as 100 excess deaths per day on a continuing basis. Yesterday, Thursday 15 March, the number of unexpected deaths since the beginning of this year was reported in the Independent as being over 10,000. That is 12.4% more people dying in England and Wales than would be expected at this time of year and that is well in excess of the 100-a-day estimated by the BMA.
If ambulances cannot respond and thousands of hours are being wasted by an inability to swiftly transfer patients from ambulances into A&E then it is clear that patients’ lives are at risk.
In the East Midlands according to the HSJ, Nottingham University Hospital Trust’s chief executive has said that their STPs should be reviewed because they currently have insufficient capacity and the STP had expected them to have disposed of a further 200 beds over the next two years. To repeat the words from Robin Walker commenting last year on the crisis at Worcestershire Royal: “a significant expansion of A&E is needed as it is now serving the whole of Worcestershire. When it was built in the 1990s it was built to just cater for people living in Worcester.”
Campaigners probably don’t need reminding that there was another large fully equipped District General Hospital in neighbouring Redditch, The Alexandra which was downgraded, whose patients are now being diverted to the Worcestershire Royal with its inadequate bed numbers and shortage of staff.
This is the reality of the STPs. Expectations that bed numbers will increase or not be cut seem unreasonably optimistic even though the need is apparent to the most casual observer. Politicians, NHS leaders and think tanks continue to pin their hopes on the 5 Year Forward View.
“It is a real challenge to get across the valley of death from where we are now to the sun-lit uplands where it all works” as Nigel Edwards, Chief Executive of the Nuffield Trust, described the situation in a Health Select Committee oral evidence session. This vision is of an integrated service where all the local authorities and public health provide a combination of a healthier, more resilient population cared for at home, alleviating and reducing the need for urgent and emergency admissions to acute hospitals.
The contrast between this rosy optimism of jam tomorrow and the stark reality of excess deaths, extreme queues of ambulances and trolley waits surely gives the lie to any consideration that Jeremy Hunt may have been worthy of his claims to be improving patient safety and preventable patient deaths.