Defend Our NHS leader : Why we must keep both A&Es open

"Two frightening paragraphs are tucked away on page 48 of Shrewsbury and Telford Hospital NHS Trust’s (SaTH) 62-page document on the overnight closure of one of our A&Es.

It says if A&E at Telford’s Princess Royal Hospital closes overnight ‘critically-ill patients with compromised airways will not have access to relevant specialist care. Patients will be conveyed to neighbouring trust via paramedic emergency ambulance’.

The decision-makers at hospital trust SaTH understand that there’s a problem in having specialist head and neck care at Telford but the only A&E at Shrewsbury.

They know this will affect critically-ill people who can’t breathe properly. Their ‘solution’? ‘Not our problem’.

These patients can’t get enough oxygen into their bodies. They may need emergency ‘intubation’: a tube put down the throat to keep the airway open.

That can be hard to do for people with facial burns, anaphylaxis, an acid attack or a severe facial injury. And in particular, children can be hard to intubate – which is why women’s and children’s and head and neck specialities are on the same site at Princess Royal Hospital.

SaTH chiefs want these desperately ill people to be taken by ambulance to somewhere else. A paramedic cannot do the same job as a whole team of specialists in an A&E department.

And if someone isn’t breathing, you have a very few minutes to play with before their brains start to die. Certainly not long enough to be shuttling children off to Wolverhampton or Birmingham in search of treatment.

Access

What on earth are SaTH bosses playing at? This is the trust that didn’t reply to a letter from Health Education England due to ‘administrative error’ – so missed out on the chance of extra doctors.

Also, bizarrely, they turned down a joint clinical Fellow’s scheme with Wolverhampton that would have given access to 140 more doctors. And now they want to close the A&E overnight at Telford because of – wait for it – not enough doctors!

The numbers slide about, but the chief executive of SaTH has told both our councils and Shropshire Clinical Commissioning Group that they are down on only five middle grade doctors. For this, they plan to spend £5 million on part-closure of an A&E, and disrupt emergency care for half a million people. It beggars belief.

Do SaTH leaders want to keep both A&Es open? Or is this an excuse to implement Future Fit early? It’s hard to know. But if they’ve got £5 million for A&E closure, they’ve got the money to secure five more middle-grade doctors.

We’ve talked to a senior doctor about what SaTH can do, if they want to keep the A&E at Telford open. We’ve written to Secretary of State Matt Hancock and we’re trying to arrange an urgent meeting with him.

There are two strands SaTH should be pursuing.

For the next few months the priority is to keep these life-saving services in place.

That means using locum doctors – and paying for them. It’s not ideal, but the safety of local people depends on it.

Oddly, our health chiefs, instead of trying to find locums, want to close the A&E overnight because they don’t want to use locums.

Deliberate

The doctor we spoke to said that trying to stop using locums in A&E was like setting fire to the lifeboats on the Titanic.

The current crisis is a deliberate one.

The second strand – the most important one – is sorting out permanent staffing.

And yes, this is possible – but it means real change.

Answering letters and being willing to work jointly with other NHS organisations would be a good start, of course. What else?

SaTH can reach out to middle-grade doctors elsewhere who feel stuck in their current jobs and want to progress to consultant level.

Offer them support, consultant supervision, time for professional development, and they are far more likely to come here.

SaTH can work with Health Education England to locate overseas doctors who have been accepted for jobs in UK hospitals in the past year but turned down because of the Government’s visa cap.

Many would still take up a UK job if it were offered.

How about SaTH paying for visas and for the visas of immediate family?

How about offering doctors the money to attract them – a ‘golden hello’ or an enhanced salary that would win them to a job in Telford or Shrewsbury? Offering accommodation for doctors and families?

Spend some of that £5 million on the doctors we need locally, instead of using it to close services down.

Valuing staff, listening to staff, making it safe for staff to raise clinical concerns – those have to become priorities for SaTH’s senior management team.

This is a troubled organisation: a shocking CQC report; an unprecedented investigation into deaths and harm to babies in the maternity service; a prosecution over asbestos safety.

In Defend Our NHS, we’re also asking if it’s time for the chief executive and medical director to go. We need change."