Why shutting A and E's is a death sentence.


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This is an edited version of a ‘Mail on Sunday’ article by David Rose, published on 11the May 2013. It is very disturbing, using Freedom of Information material he has charted the dramatic rise in death rates amongst emergency cases in the Newark area, since the A and E at Newark Hospital closed and these people now have to be taken to hospitals much further away.

I’ve already posted the lengthy comments by Dr Claire Gerada – they are well worth reading.

Of course, it’s what campaigners have been saying for years. It’s common sense. But to prove common sense you need big double blind studies over many years, costing huge amounts of money and subject to rigorous peer review. None of that is ever going to happen and we just don’t have time anyway.

Shutting hospitals and A and E’s is so much simpler;

 

Death rate jumps more than a THIRD after department closes

  • Health Minister orders investigation as Mail on Sunday uncovers rise
  • Data revealed under FOI rules show 37% rise in emergency patient deaths
  • Accident and Emergency in Newark, Notts, closed two years ago.

11 May 2013

By David Rose

 

The Mail on Sunday today reveals the first shocking evidence that hospital casualty department closures are costing hundreds of lives.

Official figures uncovered by this newspaper show a 37 per cent rise in death rates for emergency patients from Newark in Nottinghamshire, where the Accident and Emergency unit closed two years ago. 

The figures, obtained under the Freedom of Information Act, come from the NHS trusts where Newark patients are now sent. They amount to the first authoritative study on what can happen when an A&E shuts.


Increase: The number of emergency patients dying since Newark A&E closed has risen by more than a third



Data: The Mail on Sunday obtained statistics on death rates from NHS Trusts

They show:

  • Of 5,441 Newark patients admitted for emergency treatment last year, 264 died – 4.85 per cent. Yet in 2009, when there were 5,431 emergency cases, just 192 patients died – 3.53 per cent. That was the year before NHS chiefs decided to close Newark A&E, promising ‘more lives being saved’. If the percentage rate had stayed the same after the closure, that would have meant 72 fewer deaths last year – in just one area, and in just one year.

  • When Newark had its own A&E  its death rate was lower than in nearby areas – despite the fact that the town has a higher than average elderly population. Now the Newark rate is higher.

  • Like other hospitals where A&Es close, Newark General now has only a so-called urgent care and minor injuries unit – banned from treating life-threatening conditions.

Having initially refused to investigate the MoS findings, health chiefs had a change of heart last night and, at 8pm, pledged to examine our evidence.

A spokesman for Health Secretary Jeremy Hunt said: ‘We always take changes in mortality data seriously and will look into the case in Newark in more detail.’

The U-turn came after doctors’ leaders said the data suggested the policy of axing A&E units was placing lives in jeopardy. They called on Mr. Hunt to order an immediate moratorium on further closures until more is known about their likely effects.

Their call was echoed by Tory MP Andrew Percy, a leading member of the Commons health committee.

Mr. Percy said: ‘These shocking figures confirm what many local people already suspected. Shutting local A&E Centre’s does not improve patients’ survival changes, it dramatically worsens them. 

‘There should be no more such closures until we have a thorough review of this policy.’

Mr. Percy said the closure policy was begun under Labour and ‘regrettably’ not reversed by the Coalition.

Even a former Coalition Health Minister said the closure programme should now be reviewed.

Liberal Democrat MP Paul Burstow, the former Care Services Minister, said: ‘I find these figures on death rates very worrying. ‘I do have misgivings ... it is now time to review the whole approach.’

Chairman of the Royal College of General Practitioners Dr Clare Gerada said yesterday: ‘The Newark data revealed by The Mail on Sunday points to a close association between A&E closures and mortality. It is clear the provision of emergency care is in crisis across the whole of the NHS.

‘Before any further closures are contemplated, there must be a full, independent assessment of their impact on patients and on the system as a whole.’


IN RESPONSE...
Throughout yesterday Mr Hunt’s spokesman said the Health Secretary would not answer these questions as, she said, this newspaper had not established that Newark’s rising death rate was caused by the A&E closure – because the rise began in 2010, the previous year. 

Yet the figures reveal admissions there were already falling. With the axe poised over the department, ambulances were being told to take serious cases elsewhere.

But at 8pm last night Mr Hunt’s department changed its position.

A spokesman said: ‘We always take changes in mortality data seriously and will look into the case in Newark in more detail.’

She added that a closure in one hospital was likely to worsen the pressure elsewhere.  

One consultant from North-West London, where five out of nine A&Es are set to be closed, said: ‘Newark tells us what happens when you close an A&E. As a frontline hospital consultant, these excess deaths are no surprise to me, and they clearly demonstrate the risk.’

The figures – which detail the number of patients who die within 30 days of admission to an A&E unit – have come to light in a week when Ministers have finally admitted that emergency provision nationally is in deep crisis.

There has been a doubling of the number of patients forced to wait more than four hours for treatment over the past 12 months.

David Prior, head of NHS watchdog the Care Quality Commission, has said the entire health system is ‘at the brink of collapse’ because of the pressure on A&E. 

Yet in the face of this crisis, health chiefs are pressing ahead with an unprecedented programme of A&E closures and downgrades.

As this newspaper and its readers have been saying for the past 11 months, this is soon set to affect no fewer than 34 hospitals.

One of the most shocking aspects of the cuts is that there has never been any independent academic study of their potential impact.

This means the arguments made by supporters of the closures – that most patients will be better served by travelling to ‘superhospitals’, even if they face longer journeys – have to be taken largely on trust.

There is evidence that some patients, such as stroke victims, are more likely to survive if taken immediately to major Centre’s where they can receive specialist treatment, rather than an ordinary A&E. Indeed in Newark stroke death rates have declined slightly.

But other research, led by Professor Jon Nicholl of Sheffield University, has found that overall, mortality will increase with longer ambulance journeys.

Further FOI data shows the average time between a 999 call in Newark and transfer to A&E at King’s Mill Hospital, near Mansfield, or Lincoln Hospital is almost two hours. In ten per cent of cases it is nearly three hours.

These hospitals, where most Newark emergency cases now end up, are both more than 20 miles away, along roads which can be difficult even for an ambulance with a blue light.

Professor Nicholl said: ‘The research indicates there is a relationship between the distance to hospital and mortality.’

Dr Clive Peedell, a consultant oncologist who is also co-leader of political party the National Health Action Party and chairman of the NHS Consultants’ Association, said it was now evident that pressing ahead with further closures would be ‘disastrous’.

He said: ‘There is no evidence base to justify what they are doing. In A&E trauma cases, doctors talk of the “golden hour” for treatment when patients’ chances are maximised. If it’s taking nearly two hours to reach hospital, mortality is bound to increase.’

In the case of Newark, The Mail on Sunday can reveal that David Bowles, the former chairman of the trust which runs Grantham and Lincoln hospitals, warned senior NHS management that increasing the burden on services there would have disastrous consequences.

He said that when closing Newark’s A&E was first mooted in 2009, he had warned the now-disbanded East Midlands Strategic Health Authority (SHA), the body which pushed through the closure, that Lincoln Hospital was already ‘close to a tipping point’ because its patient load was so great.

‘There were no vacant beds at all, and yet the SHA was saying we had to admit more patients,’ he said. In such circumstances, it was likely that patients would be sent to the wrong ward, and the control of ‘superbug’ infections would suffer, along with patient care in general.

Mr Bowles’s concerns were ignored. Now, in the wake of the Mid-Staffordshire hospital scandal, both Lincoln and King’s Mill are among 14 hospitals being investigated over ‘excess’ patient deaths.

Meanwhile, a report commissioned by the Say Yes To Newark campaign from independent health think-tank Dr Foster has found ‘higher than expected mortality’ among emergency case patients from the NG23 and 24 postcodes treated at Lincoln from 2008 to 2011. Doctors in other areas facing A&E closures now fear similar consequences. 

The trusts which run the hospitals where Newark patients are treated refused to comment yesterday.

They referred questions to Amanda Sullivan, chief officer of the Newark and Sherwood Clinical Commissioning Group – the GP-led body now responsible for buying hospital services in the area.

She claimed the increase in mortality was caused by Newark patients being ‘ill-er’ than they used to be because they have aged, while the criteria for admitting emergency patients to hospital had become stricter.

Those who might have been given beds in the past were now sent home, so that those who were admitted were ‘more likely to die’.

She admitted she had no hard data with which to back her assertions, but she insisted: ‘I don’t think the change [to Newark A&E] has worsened mortality.’

Last night a spokesman for Mr Hunt pointed out that the death rate increase began in 2010, the year before the A&E closed.

'MY MOTHER HAD TO TRAVEL 20 MILES AND DIED IN MISERY'

Muriel Powell, 85, was one of thousands of emergency patients affected by the closure of Newark’s A&E in 2011. 

She had been in good health, but when she started to cough up blood, her family dialled 999. 

A paramedic in a car was soon on the scene, but Mrs Powell had to endure a long wait for an ambulance to take her to Lincoln, more than 20 miles away.

Her daughter Pauline said she was eventually diagnosed with leukaemia. ‘They were constantly taking bloods, causing her great pain.

'No one lives for ever. But you do expect people at the end of their lives to be treated with dignity and compassion. That didn’t happen. My mother died in misery.’ 

In 2011 and 2012, Lincoln Hospital admitted 1,800 Newark emergency cases a year.

A staggeringly high proportion – 8.15 per cent in 2011 and 7.82 per cent last year – were dead within 30 days.

This is more than double the average death rates at Newark when it had its own A&E.

The original is at the Mail.

Neil Harris
(a don’t stop till you drop production)

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