Crisis? What Crisis?

As the NHS goes into meltdown once again both locally and nationally we asked NHS lobbyist and regular thorn in the side of Health Ministers and officials past and present HUGH McCLOY to give us his personal view on the latest crisis in A&E.

You can follow Hugh on Twitter here and keep up to date with his campaign for the return of Acute services to the Mid Ulster Hospital here.

Crisis What Crisis

This Winter Crisis of 2015 is not the same as the Winter Crisis of 2014 which was caused by different issues from the Winter Crisis of 2013. Considering that the winter crisis of 2012 was bad it is in no way linked to the Winter Crisis of 2013, 2014 or 2015 – it was a good performance compared to the Winter Crisis of 2011. The Winter Crisis of 2010 however is where all this begins.

What happened in 2010?

Prior to this from 2007 we had seen the closure of 3 A&Es – Mid Ulster, Omagh & Whiteabbey – and a loss of beds and wards for financial reasons across the country. This led to the 2010 crisis and this has been repeated year on year to one level or another.

Stop Blaming Patients

While there are many people blaming patients, politicians would like to blame people who “should not be there”; I ask you “who should not be in A&E”? Everyone in a decision-making position in health knows it is the patient who is acutely ill and needs admission who is causing A&Es to fail, not because they are ill, simply because there is no bed for them in the wards; as there is no bed then they stay in the A&E treatment cubicle or are wheeled into a corridor. This stops the turnover in the A&E and thus patients start to build up. The problem is a simple one; the answer to it is also simple – reopen the hospitals the Government closed that caused this crisis in the first place.

Take Antrim A&E for example; a brand new A&E with a capacity of 90,000 patients a year. The question is could the rest of the hospital wards behind the A&E cope with 90,000 admissions a year? It cannot. It is struggling to deal with in the region of 30,000 direct admissions from A&E a year on top of other pathways to the hospital wards such as GP admissions.

The first review carried out specifically for a failing A&E system in Northern Ireland was in Antrim – the Ruter & Hinds review http://www.northerntrust.hscni.net/about/1615.htm I was in the boardroom meeting after this review. Valerie Jackson who was the Acute Director of the Northern Health & Social Care Trust specifically stated in her breakdown of the review that 90% of people waiting in A&E were waiting on a bed. Having a minor injury did not even factor in the analysis.

When you step back and look at the issue, how many people are travelling to A&E knowing that even on a good day they could face hours sitting in the waiting room if they do not think they have to be there or have somewhere else to go for treatment? Remember the alternatives being suggested are already as stretched as the A&Es with the lowest ratio of GPs per person in 24 years: http://www.bbc.co.uk/news/uk-northern-ireland-30585450 . Minor Injury Units have very limited opening hours and most cannot treat children under the age of 5 even though all they have is a minor Injury. The Doctor on call service is again stretched and like many people who will have used it instead of being seen you are referred to A&E

The problem is simple, we have X amount of in-patient beds in our acute health system. Since the Assembly was established in 1998 the number of hospital beds available has dropped year on year. While advances in medicine have given us a faster turnaround in beds, the advancement of medicine has been outstripped by the removal of beds and the increasing readmission rates due to patient’s not being treated correctly in the first place.

Table 1

391 beds have been cut since April 2009 in our hospitals – almost 100 of them in the Mid Ulster Hospital alone, a 9% loss. In total 1,114 beds have been cut from our health system across different areas since April 2014.

  • Non-Elective inpatients, treatment regarding the critical care and life of a patient has risen by 12%, roughly an extra 20,000 cases a year since April 2009.
  • The amount of day cases has risen by 10% in the region of 18,000 a year.
  • Total admissions increased by 30,000 between 2009 and 2013.
  • Elective inpatients, the type that has now been called off by the Health Trusts on first glance looks like it has dropped significantly by 17% – roughly 10,000 episodes. This is not telling the full story. Since April 2009 as the health service was falling apart due to lack of capacity and ward closures more patients were being sent to the private sector. In 2009/10 there were a combined total of 86,249 non elective cases, in 2013/14 there was a combined total of 80,502 a drop of roughly 6,000 episodes.

To put this into context we have seen a 9% loss of inpatient capacity against a 12% rise in the amount of life saving episodes needed to be carried out. With non-elective care already being stopped in the private sector without the public sector being increased waiting lists rise. The maths simply do not back up the claim that changes in health provision were made to save people’s lives.

Table 2

Take into account A&E departments are only a door to the hospital; other doors include for example direct GP admissions to the wards. When the wards fill up A&Es and other areas such as theatres cannot function as there is nowhere for the patients who need admitted to go.

The problems I am speaking off are one part of the puzzle. Look at these performance stats and see with your own eyes. Forget empty MLA press statements they are meaningless!

Table 3

Table 4

Table 5

The Blame Game

Maybe blame the doctors and staff? The ever-changing landscape of health services in Northern Ireland has left this area a no-go zone for health professionals. How many doctors and consultants will choose Northern Ireland for a long-term career when there are no guarantees that there will be a long-term career? The loss of hospitals also came with the loss of doctor training posts for both home-grown doctors and international students. We had a system that worked and it is not too late to revert back to that model.

If you are looking someone to blame look at Sinn Fein’s health strategy from 2001 to 2011 with multiple closures of services including Mid Ulster, Omagh and Whiteabbey. The entire Northern Ireland Executive in 2007 for the Review Of Public Administration which again led to service cuts and the Comprehensive Spending Review of 2008 from the Executive which saw the UUP fast track Sinn Fein’s health strategy with a few extra cuts of their own

All of the above led to a major cuts in acute care in Northern Ireland. If you don’t want to blame any of the above then let’s blame the DUP. Their health strategy is to social care what Sinn Fein’s was to acute care – cuts. The Alliance Party & SDLP are part of the executive and could have done more but sat silently when push came to shove.

Or blame finance, that’s an easy one to hide behind. It will always be an issue however; between each health trust is spending £500,000,000 a year buying private care; it is time to filter that money back into public services to provide the system that worked instead of firing more money at a system that has failed. MLAs know this but they first must admit they got it wrong and accept that no amount of finger-pointing at Health Trusts will make it better. With the assembly set to take millions in loans along with austerity cuts to the health service required to be able to pay the loans back the outlook is not good.

Or will we look at the private sector and see if we can put some blame on there. It is true that if you are on a year-long waiting list in the public sector for an operation if you go private you will be treated in a matter of days. Maybe there is a hidden agenda here to deliberately make public services fail so that the Assembly and “political donors” and big business lobbyists get their payback by privatising acute care as is happening in England & Wales.

Let’s stop laying blame and demand accountability. This starts and stops in Stormont and if we keep electing politicians who no more care if you live or die then ultimately people will die.

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  • Reader

    The Firemen: The problem is a simple one; the answer to it is also simple – reopen
    the hospitals the Government closed that caused this crisis in the first place.

    Sloppy thinking there – the need is for more hospital beds, not for more hospitals.
    Or, to be even more specific, the need is for more available hospital beds in the right place at the right time. There may be more than one way to achieve that.

  • hugh mccloy

    The need it there, the only place hospitals can go now is build up, or expand by using portacabin units that you are seeing in Antrim and the Royal which come with associated medical risks for patients.

    On the system failure the smaller hospitals took the load of intermediate care leaving the larger acute facilities with the bed space for patients, the Mid Ulster once has 200 fully acute inpatient beds, now there is 20.

    Remember that the bulk of these issues came about post the closure of Mid Ulster and Whteabbey, once Antrim filled up patients were sent else where, whit other closures the network is full and also remember that a risk assessment told the trusts and government that the highest risk to patients in Northern Ireland and the acute network was to shut Mid Ulster of A&E and its wards without first building phase 2 of Antrim.

    Antrim is a 2 phase hospital with only one phase built and phase 2 will never be built, it was supposed to get 200 extra beds to cope with taking away Mid Ulster and Whiteabbey, as phase 2 wont be built it makes more sense to utilise wards that are now laying dormant for intermediate care in former hospitals.

    The over flow of the Northern Trust spilt into the SHSCT, BHSCT and along with other cuts there we see what we see today, local hospitals served as the safety net for the larger acute hospitals, that model need to be restored.

    If you are from an area where A&E’s were removed or anyone who reading this is would know what I mean: if you had a sick family member taken to the Mid Ulster for example you would be hoping for the best and a quick recovery, if they were then moved onto the Royal or Antrim then you knew they were very ill. But while in the Mid they got treated quickly stabilised if needed and then moved.

    Not what we see now which is life saving ambulance calls only arriving on average 44% r of the time under the target time in Mid Ulster and worse i other areas, to be driven further to get to an A&E, to face waits there and a high possibility of no bed after you get seen in A&E. The hospitals that you are being taken to are over crowed, under bedded, under staffed and a high possibility that there is only locum consultants to diagnose you. If you need further treatment your sent home with a care package, if you can get one, and then back on a waiting list.

    They are already expanding some wards in the Antrim Hospital but due to space limitation the brand new neonatal wards are built below infection control specifications in regards to spacing between the cots. This has been allowed to pass through the tender process of DFP, RQIA and the Health Minster. If in the future there is an issue and children get sick or die during a outbreak an I told you so wont bring them back and it is not so long ago that we had a outbreak.

    As I stated the turnaround in beds is improving, social care is being reduced making it harder to discharge and hospitals are discharging early leading to 1,000’s returning within 30 days as emergency cases.

    Speak to most doctors they will say the same, we had a working system that was broken by Stormont.

    In 1998 when the assembly came about it had the first of four spending reviews, the then Sinn Fein health Minister carried out the consultation to shut hospitals, only the Assembly collapsed in 2002 we would have reached this point earlier, as the plans drew up them which started with getting rid of Omagh Hospital and downgrade Mid Ulster and Whiteabbey were put in place.

    To note when direct rule Ministers had the call to shut the hospitals here from 2002 to 2006 they didn’t as they know and acted on the clinical risk in removing local hospitals from areas where there was demand for it and where travel issues could not be met by simply say go to another hospital.

  • notimetoshine

    In my own personal experience as a carer for my grandmother the lack of an efficient social care process is part of the problem. She was admitted with a severe chest infection and the resultant complications. She was in hospital for just under four weeks but was well enough to have returned home a week and a half before she did. The reason: a delay in her being assessed for home care and the resultant care being out in place. The medical staff were quite clear that hospital was not the place for her to be and that it was detrimental to her mental state (her cognitive function was severely impacted whole there) but what could be done?

    So she held a bed she didn’t needed denying that bed to others, and was in an environment not conducive to her recovery. This resulted in her needing more complex care as,her mental state was badly affected and no doubt put a strain on the hospitals resources.

    I don’t know how prevalent this is, but between the woman in the bed beside my gran and stories I have read this is a significant factor in the problems with beds in the NHS.

  • Micky

    Well said, I have been following Hugh for quite some time and agree with him on that we had a system that worked, now we don’t.

  • initialb

    obviously the idiots who shut down our hospitals aren’t too worried as they can afford private healthcare with all the money they rape from us , anyone would think the government is trying to thin out the population so there will be less of us to protest when they decide to close another hospital. .. shower of bastards .

  • Zig70

    24/7 theatres and make the operation centred on theatres not the doctors. NHS staff are far more mobile than theatres. Also need to deal with the alcohol factor in A&E. Either tax alcohol to pay for it or force the numpties with self inflicted accidents to pay. I’d actual favour a dedicated A&E for those over the limit, staffed by butchers and lit with tea lights in a wee hut to the side. Though I have been there myself, own fault too.

  • streetlegal

    John Compton, who is personally responsible for much of the chaos we are now seeing in hospitals in N. Ireland, has now set himself up as some kind of expert commentator on public health administration. The brass neck of this man is unbelievable.

  • hugh mccloy

    He walked away with a CETV pension fund worth over £1.6 million, like Dr George O Neill who we hear quite a bit of now, both men had decision making powers that led to the breakdown of the system and both now have the neck on them to “objective commentators” , that’s a big part of the problem.