MYTH BUSTER

Click on the + to reveal the TRUTH #savesouthend

MYTH 1 - Patients will get better treatment and have better outcomes at a specialist centre A&E. (The Essex Success Regime spin)

TRUTH 1

There is very limited evidence for improved outcomes in accident and emergencies that are bigger – and that is precisely what Basildon will be, just bigger. Whilst there is some limited evidence that in very small A&Es, there may be slightly worse outcomes, NONE of the 3 A&Es (Basildon, Southend or Broomfield) meet these ‘small A&E’ criteria and indeed Basildon and Southend A&Es are classed as ‘large’ A&Es in their own right due to the number of attendances.

There is supportive evidence that for certain groups of patients, there is a better outcome when the diagnosis is definite, for example there is a readily available diagnostic test (or it is visible in the case of trauma) and they can be treated in a more specialist unit or A&E. These fall into four groups of patients: –

a) Major trauma patients do better in major trauma centres. Please await myth 2 ( to be published tomorrow) that Basildon will NOT EVER be a major trauma centre. Due the major trauma evidence, ALL of the UK’s hospitals ARE ALREADY organised into trauma networks which work to get the patient to the right centre as safe as possible. For some patients this will mean direct transfer by helicopter or ambulance to the regional trauma network trauma centre. For incidents in Basildon and Southend catchment area, they will transfer to the Royal London Hospital, whilst Broomfield area patients will go to Addenbrookes. Occasionally major trauma patients are too unstable to travel to the centre first and for this reason they may ‘pit-stop’ in the local A&E for stabilisation before moving onwards. This is often the case in hours of darkness when the helicopter services cannot fly. For this reason there still needs to be ready access to a local FULLY FUNCTIONING A&E that accepts blue light ambulances 24 hours a day. NOTE – Major trauma requiring transfer accounts for less than 1% of all A&E attendances.

b) Patients having a specific type heart attack which have a specific diagnostic ECG. All patients who call an ambulance due to chest pain are likely to have an ECG performed by the paramedics (unless an alternate diagnosis is very clear). For some heart attacks there are very specific diagnostic changes on an ECG – this is called an ST Elevation heart attack or Myocardial Infarction, the medical term for a heart attack. This is shortened to the acronym STEMI. If the paramedics see these changes on the ECG and the clinical story fits with a heart attack, then the pathway is ALREADY IN PLACE to take the patient directly to Basildon cardio-thoracic centre (CTC) for a particular diagnostic test and procedure where they use stents to reopen the arteries supplying the blood to the heart muscle. This has been shown to give a better outcome. It is also worth noting that the CTC is nothing to do with Basildon A&E. It is staffed and operated by different staff groups and physically is entirely separate to the A&E and hospital. However, the MAJORITY of heart attacks are NOT STEMI’s and for these other type of heart attacks, there is not any evidence that going for a stenting procedure improves outcome – therefore all other cases of possible heart attack go to their NEAREST A&E. Less than 2 patients per week from each area on average go direct to the Basildon CTC. 
Of note a heart attack is a major cause of CARDIAC ARREST – when the heart stops beating and the person effectively dies and needs resuscitation. (A cardiac arrest can occur for many other reasons too – a heart attack and cardiac arrest are two different things). Evidence shows that approximately 25% of patients having a heart attack will go into cardiac arrest. So lets look at what improves outcomes for cardiac arrest – This has been proven to be early access to advanced life support- that is a team of doctors and nurses trained to do chest compressions and use of a defibrillator to shock the heart back if appropriate. It is referred to as the chain of survival. The major factor determining successful outcome is TIME- it has been proven that for every minute delay in advanced life support and defibrillation, the chance of a successful outcome decreases by 7%. So again our further argument is that these patients need to get to the NEAREST A&E as soon as possible NOT travel further. An additional research paper has shown that over 20 minutes of cardiac arrest is associated with exceptionally poor outcomes ~ death and permanent brain injury for the vast majority of patients. Essex Success Regime has proposed changes based on a transfer time from Southend to Basildon of 23 minutes – in the context of this group of patients it is the absolute difference between a chance of life and death. Plus we firmly believe 23 minutes to be an underestimation if clinical interventions are having to be performed en route.

c) Patients who have a ruptured abdominal aortic aneurysm (AAA). The aorta is the major blood vessel which comes out of the heart and travels down the body providing the blood supply to everything. In some (often male elderly) patients, the part of the aorta in the abdomen (tummy) gradually gets bigger and bigger and in some patients suddenly ruptures. Unfortunately, this can give symptoms in a variety of different ways from sudden collapse, a faint like episode, back pain, tummy pain, pain in the legs etc. Lots of other things can also give these symptoms which are not from a ruptured AAA therefore this cannot be diagnosed in the ambulance and only in A&E usually by an ultrasound scan (which A&E doctors do now in the A&E department at the bedside so only takes minutes) and then often a CT scan. Patients then have a better outcome if they are stabilised and transferred to a centre for specialist vascular surgeons to operate on. Once again, there are already treat and transfer protocols already in operation between the 3 sites- currently all sites do this surgery but altering this to be one site ( ie Basildon) will not alter patient outcome and is not something the Save Southend A&E campaign is against. Indeed amalgamating the vascular surgeon on call rota may well be an attractive concept for them to recruit and retain staff. Of note this is only a very small number of A&E patients – less then 100 patients per year in total across all the 3 sites, so it doesn’t make any difference to the need to have other services staying available for everyone else.

d) Patients having a stroke (CVA) that fits the criteria for clot busting drugs (thrombolysis) to be given. Once again the important thing for improved outcomes is TIME. The ideal situation is for the patient to start receiving thrombolysis within 30 minutes of arrival to the A&E. This is a very tight target to do as the patient must have a full clinical assessment plus a CT scan performed before the drugs can be given. For patients to have to travel an extra (ambitious) 23 minutes before even getting to Basildon A&E will again affect patient outcomes. The stroke service have analysed the outcomes of moving from three A&E centres who give thrombolysis as it currently stands to two or one and the outcome is MUCH WORSE for patients, who will have higher permanent disabilities and higher death rate. Indeed the costs of looking after these permanently disabled patients actually is even more expensive than the potential savings of amalgamating services. So it doesn’t make sense on either a clinical or financial basis to do this.

The above four groups of patients have evidence for specialist centres or transferring but still form in total a VERY SMALL number of patients who attend by blue light ambulance every day. The 3 A&Es between them have around 950 patients a day and about 250 come by emergency ambulance per day. What about the outcome for all these other patients? There is scientific evidence that the increase in journey time for ambulance patients to an A&E further away causes more deaths. In studies based in the United Kingdom this has shown to be in the order of an extra 1% death rate for every 10 kilometres travelled. How can this even be considered? Despite that being bad enough, the evidence gets even worse for some patients groups. If you have a respiratory problem such as asthma, severe shortness of breath, COPD (chronic obstructive pulmonary disease) or heart failure, the death rate doubles to an extra 2% per 10km travelled. To increase this impact further, Southend has been proven to have a higher than average number of patients with respiratory problems.

In summary we believe that there will be a worse outcome for patients, with no evidence that these changes will have an improved outcome from the current A&E processes that happen now. This is not a proposal based on better clinical outcomes, this is going to kill patients.


MYTH 2 - Various publications and press have stated that Basildon will become a SPECIALIST TRAUMA CENTRE. This fools the public into thinking that downgrading Southend is 'ok' as there will be a new, amazing A&E that will save more lives. Wrong

TRUTH 2

There are NO PLANS in place for this to happen and neither should there be, as there is already a very well established trauma network in place. A large number of medical specialties are required to be on site 24/7 every single day of the year for a hospital to be a designated ‘trauma centre’ and Basildon DOES NOT and WILL NOT have any of these on site.

For Basildon to be a ‘Trauma Centre”, Neurosurgery would be required for patients with traumatic brain injury. Currently this is provided at Queens Hospital Romford, where they have purpose built neurological ITUs and theatres. Neurosurgery, like trauma, was set up in a network of hospitals many years ago as the number of patients needing to have emergency neurosurgery means that not every hospital could support a team with enough work. It is also been proven for neurosurgery that having centres specialising in certain numbers of cases give better outcomes for patients.

For Basildon to be a ‘Trauma Centre” there would also have to be Trauma Cardiothoracic Surgeons on site. Whilst Basildon does have a cardiothoracic surgery centre, THEY DO NOT OPERATE on trauma cases. They ONLY do elective planned procedures and as you can imagine the management of these differs very much from someone with stab wounds or gunshot wounds to the chest. ALL trauma cardiothoracic cases go to the current regional trauma centre and NOT to Basildon Cardio Thoracic Centre. In addition a team of interventional radiologists would be needed who are required to manage complex pelvic fractures are NOT currently on site in any of the 3 hospital A&Es except one working in Southend. Basildon CAN NOT be a Specialist Trauma Centre for the lack of the above specialties.

Throughout the Essex Success Regime options appraisal (where just 43 members of the public were invited from an A&E population catchment of 1.2 million) , there has NOT been any plans to alter the types of services and specialties available at the Basildon ‘bigger’ A&E. It will NOT be any more specialist that any of the current 3 A&Es (Bas, Broomfield, Southend) and it will just be bigger and busier – serving a combined population of 1.2 million people – potentially the busiest A&E in the country. The conclusion is that Basildon will not be a ‘Specialist A&E’ and definitely will NEVER be a trauma centre, despite what many MPs have stated or what has been reported in the press. Believe the clinician led truth and NOT the glossy media spin.

MYTH 3 from Essex Success Regime "There will be a full 24/7 A&E staffed by A&E Consultants on each site."

TRUTH 3

The Success Regime Essex proposals detail “orange” and “yellow” A&Es which are their favoured type of A&E departments for Broomfield and Southend. See pinned post at top of our Facebook page for the image) Under both of these options, the A&Es will have 999 emergency ambulances diverted AWAY from them at certain times of the day, or possibly altogether – with the favoured option being that Basildon is the ‘specialist’ A&E which accepts them all irrespective of distance that patient has to travel or how critically ill they are. (See myth 2 posted previously for the actual truth about what Basildon will be – just busier, bigger, not ‘specialist’ and not a trauma centre).

Any A&E not accepting ambulances is NOT an A&E and this is political spin to continue to call it an such. This is purely being done to fulfil the promise of keeping an A&E 24/7 on each site and falsely reassure the public. By definition, if our A&E is downgraded then it will be a WALK IN CENTRE – as they are the only type of patients that will be accepted there.

There are also statements which have been released claiming that GP ambulances will still go to Southend- this is again twisting the truth a little to reassure people. If you have seen your GP and they think you need to be seen in the hospital as an emergency that day – they will refer you to the specialty team on call for your problem e.g. medicine, surgery, paediatrics. If it is felt you are ill enough to need an ambulance to get there then the ambulance will take you to Southend BUT as already happens now, they will go direct to the unit expecting you- such as the acute medical, surgical, paediatric units. These ambulances are in effect NOTHING to do with A&E.

So, to clarify, the only patients coming in to the A&E department have in effect ‘walked in’ and by definition, have less severe and different pathologies than those who come by ambulance.

Now the gritty bit – the real truth. The A&E doctors and nurses have chosen to specialise and work in A&E because this is their vocation and they love the variety of receiving and treating all kinds of patients. The variety of seeing such diverse and different cases each day is cited as the main attraction to working in A&E. Most experienced A&E staff will NOT want to stay and work at this ‘A&E’ (walk in centre) which doesn’t actually have any 999 emergencies coming through the doors. Any junior doctors in training will not be able to be employed there- they have to see a wide variety of all kinds of cases and no ambulances will mean they are unable to get all their required assessments completed. This will result in not enough doctors to see patients, particularly as many non-training posts are doctors getting experience after coming from abroad to get a training post. It is therefore highly likely the ‘A&E” (walk in centre) would have to shut eventually as it would be unable to attract staff of all grades for required safe staffing levels. All of the current specialties (such as medicine, surgery and paediatrics) get the majority of their emergency admissions each day from A&E. There is great risk to a number of specialties whose Consultants will also leave because they too are not seeing all the patients they have been trained long and hard to care for – they do not want to lose their skills, expertise, ability to conduct research.

History has shown stopping ambulances going to an A&E inevitably leads to it closing some years later- there are many examples of this around the UK such as Canterbury, Dover, Grantham.

We must stop the proposed downgrade and ensure our A&E continues to accept 24/7 999 emergency ambulances or it will be the death of Southend Hospital.

MYTH 4 #Spin Rationalising A&E services to mostly one hospital site allows elective work i.e. operations to be carried out on time reducing waiting lists and cancellations

TRUTH 4 #NoSpin

Waiting lists and cancellations are nothing to do with how A&E functions. They occur due to the overwhelming number of emergency inpatients- mostly elderly frail patients needing to be admitted for treatment. As these patients are admitted as an emergency and therefore the number of admissions is unpredictable each day, every one of the 3 hospitals involved often runs out of elderly care beds for them to be nursed in. This particularly happens in winter when admissions are high and people are sicker due to the increased severity of respiratory problems (Just a note- think back to myth 1 and the mortality for respiratory problems again). These patients then end up being nursed on wards wherever a bed is available such as surgery, gynaecology and orthopaedic wards and not medical wards.

As there are now ‘unexpected’ patients in these beds, it means that a patient waiting for their operation cannot be admitted and theatre lists are cancelled thus waiting lists grow.

There are not enough beds for this type of elderly frail patient IN TOTAL in ANY of the 3 hospitals. These proposals do NOTHING to address this issue and no single hospital site is large enough to cope with all of these patients. However, the Essex Success Regime plan would seem to be that shuffling around where these patients are between the 3 sites will somehow solve this problem when there is no net increase in the number of beds in total. This clearly by anyone’s maths, this does not work.

Moving patients to another hospital away from their home town is likely to be detrimental to their care and result in longer admissions. For this vulnerable elderly group, this will reduce the likelihood of their relatives being able to visit as they now have miles to travel. The Essex Success Regime will argue that extra public transport is going to be commissioned- and Mr.Duddridge has already stated in constituent letters he has spoken with Arriva bus company ( do we smell a done deal?!) and of course lots of visitors will drive too – That’s extra traffic now travelling down the A127 and A13 – you know, the roads the 999 ambulances will be battling through to get their emergencies to Basildon.

In addition to that, evidence has shown that moving this elderly group of patients from one ward in a hospital to another ward in the hospital actually increases their admission duration by a day! So now to factor in what moving between a HOSPITAL will do- all those patient staying another day or more means we need even more beds…… which of course is not anywhere in the plans. Nor has the repatriation of these patients once well thus placing huge increased workload for the ambulance service.

Until there is effective social care, admission avoidance schemes and enough care packages and nursing homes for speedy discharges, operations will still be cancelled and waiting lists remain. The proposals remain critically flawed.

#SaveSouthend #NoDowngrade

MYTH 5 - #Spin Essex Success Regime like to report that designating Basildon as a 'specialist emergency centre' will attract staff and decrease vacancy gaps.

TRUTH 5 #Reality

Basildon will NOT be a ‘specialist centre’ -it will just be bigger and busier A&E (possibly the busiest A&E in the whole country according to some of the figures). Look back to Myth 2 – that Basildon WILL NOT be a ‘major trauma centre’ .

Huge, impersonal emergency departments are NOT attractive to A&E doctors and nurses -in actual fact, it is likely to deter staff from working there. Southend A&E is busy enough as it is. In most of the 3 A&E departments now ( Bas, Broomfield, Southend) the team running each department consists of around 100+ people- doctors, nurses, health care assistants, reception staff, porters, cleaners. They all work as a team and need to know their team to get the best from each other to deliver the best patient care. A&Es are a unique hospital department and the very nature of the high stress, fast paced workload requires staff cohesion, trust, confidence and personal knowledge of each team members experience, skill base and capabilities. It is this level of teamwork and bonding which assists when making split second decisions about emergency care of the sickest patients. To make an A&E even bigger, like Basildon would have to be, then staff may have to work with over double the number of staff members in the team and that is according to Essex Success Regime (ESR) figures, not ours.

The ESR will not put their money where their mouth is and have refused to do any risk analysis of staff leaving, (despite multiple specialties raising it as a huge concern) simply because we believe they will not like the results. They continually plan for Consultants to be working at all of the 3 sites but we are aware that there are many Consultants ( plus other healthcare professionals) who have moved with their families to this area and they will not readily accept a new way of working, which could involve an additional hour of commuting each way, every day to work – especially when they know that outcomes of their patients will suffer. Nationally and locally there is an issue in A&E staffing, recruitment and retention and having just one single BIG A&E will not solve this, in fact it will make it worse.

#SaveSouthend #NoSpin

MYTH 6 - Southend A&E will not close

TRUTH 6
Plans suggest that it will be open 24/7 but this will be a walk in facility only – but with no emergency ambulance admissions, there will be no regular, experienced staff wishing to work there and it will eventually close (which has happened elsewhere in the country)

MYTH 7 - Any emergencies arriving at the hospital will continue to be treated and stabilised

TRUTH 7
Arriving at the hospital as a ‘walk in’ due to plans for no emergency ambulance admissions . They won’t be treated and stabilised by experienced and suitably qualified staff as they will have left for roles elsewhere. Before they leave it will be unsafe, as with no emergency ambulance admissions, staff will not be as familiar with emergency management. Studies show staff lose life support skills quickly if they do not use them often
#SaveSouthend

MYTH 8 - The specialist centre at Basildon will have 24/7 Consultant cover

TRUTH 8

There are not enough Consultants in the whole region to do this at present, let alone also continue to staff Southend and Broomfield A&Es which apparently will remain 24/7 for walk in patients under proposals AND ALSO will be fully staffed by A&E Consultants to cope with critical emergencies that may ‘walk in’. The numbers DO NOT add up and we have the evidence to prove this.
#SaveSouthend

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