The old, and still current in many cases, model of the A&E department at your nearest hospital was that it would be staffed at night and the weekend by someone called an A&E consultant who was basically a general surgeon with some specialist emergency training.
He could deal effectively with the great majority of people and injuries turning up at A&E. But if you turned up at the weekend with a stroke, a serious heart attack, a smashed skull, or been run over by a bus he would do his best to patch you up until Monday morning for the serious specialists to do their job. People died.
People who would have been saved if they had had specialist surgery immediately, died. It is called the weekend effect.
The NHS started some years ago setting up specialist units to counter the worst of the weekend death toll. The major trauma centre at St Mary’s Paddington is one of a small number in London staffed by specialists round the clock. The ambulance knows to take you there if you have a smashed skull and the brain surgeon will deal with it immediately. This has saved many many lives.
The brilliant Charing Cross stroke unit will start specialist remedial treatment immediately so your chances of walking out rather than being pushed out, crippled, in a wheelchair, are hugely higher.
Survival rates for heart attacks have gone up by 40% since ambulances take you straight to the specialist heart unit at Hammersmith Hospital.
The NHS ‘Shaping a Healthier Future’ proposals were designed to take this one step further, so that all life threatening conditions would be automatically taken to a major specialist emergency centre with the full range of specialist consultants on duty twenty four hours a day seven days a week. For minor emergencies, which is about 80% of all the people who currently turn up at A&Es, the nearest hospital would still deal with it.
But the NHS made three serious mistakes:
- First, they failed to explain clearly what they were doing and why
- Second, they refused to allow anything except these new ‘super’ A&Es to call themselves that, so everything thought that they were withdrawing all accident and emergency services from many hospitals – and even now they still can’t decide how to define an A&E
- And, catastrophically, they decided that on the back of the A&E changes they would close virtually the whole of Charing Cross.
Clearly, we could not agree to that.
But as an administration, during the course of the intense scrutiny of the consultation period, we realised that we were going to lose the argument with the NHS to make Charing Cross the major A&E – despite its better geographic location than Chelsea & Westminster, which was the alternative.
So we set about trying to save everything else at Charing Cross that would otherwise have been closed. All the specialist clinics where so many people go for superb treatment. I believe that we succeeded as well as was possible at that stage, and extracted from the NHS a further proposal – call it the Enhanced Option – which they unveiled to the Joint NorthWest London Scrutiny Committee in Febuary 2013:
- We saved the full range of diagnostic facilities, including MRI scanners, computer imaging, endoscopy, ECG and ultrasound.
- We saved the cancer clinic, with cancer diagnostics, chemotherapy and radiotherapy treatment.
- We saved the Maggie’s Centre.
- We saved the West London Sexual Health clinic – which does fantastic work with FGM victims
- We saved the Mental Health Clinic.
- We saved the Imperial College teaching facilities.
The essence of all this was formally agreed at the February 2013 meeting of the JCPCT (Joint Committee of Primary Care Trusts) which was the formal commissioning body, where this enhanced option together with the original basic option was formally agreed as a single package.
However the latest proposals seem to represent a step backwards. I am personally very disappointed. I acknowledge these latest plans are still hugely better than the total closure we were originally faced with. But they do appear to represent a retreat from what was agreed last year. We need urgent assurances as to their implications.