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An email exchange from a local Ambulance Trust employee

Dear David Burzotta, Stephen Habermel and Nigel John Folkard,
I’m a local Ambulance Trust employee and I am very concerned about the
STP proposal of downgrading Southend’s A&E.
Can you please confirm that you will oppose this in the strongest
manner possible and force a turn around on behalf of the people in this
I believe that this downgrade will put lives at risk due to greater
travel times by ambulance and greater waiting times for those in need
of one. Please help save lives not costs.
Yours sincerely,

Response from Kim Vann, Executive Assistant to Simon Leftley – Acting Chief Executive and Andrea Atherton – Director of Public Health Southend Borough Council

From: Kim Vann
Sent: 16 May 2017 13:24
To: Benjamin Mudd
Cc: CllrFolkard
Subject: RE: Letter from constituent Benjamin Mudd to Cllr Nigel John Folkard

Dear Mr Mudd

Cllr Folkard has asked me to send you the below reply on his behalf:
Thank you for your recent email, in which you raise a number of concerns about the proposals outlined in the mid and south Essex Sustainability and Transformation Plan (STP).
The three hospitals included in the mid and south Essex STP (Southend, Basildon and Chelmsford) are currently individually struggling to meet demand. This is due to a number of challenges, including a continued increase in demand for healthcare in addition to difficulties in recruiting the required workforce, leading to a significant number of staffing vacancies.
The STP is about a system wide change to tackle these issues with the aim of reducing demand and the need for additional hospital beds. The key components of this change are:

  • Managing demand for healthcare by people being supported to live well and stay well for longer
    This includes more work in terms of prevention and early intervention as well as supporting self- care, for example face-to-face health checks; and proactive and personalised care to help people with health risks avoid serious illness.
  • Reconfiguration of acute services
    This involves the three hospitals working as a group, with the separation of elective and non-elective care, consolidation of services and the re-designation of emergency centres.
  • Networks of care in the local area
    This strand of work is concerned with building capacity outside the hospital to support people with more complex care needs. This includes care delivered by a range of appropriate professionals to free up GPs to deal with patients with more complex needs, a wider range of services and clinics delivered closer to the patient’s home, and integration of health and social care.

Based on national evidence, it is suggested that by 2020/21 the improvements in self-care, prevention and local services will lead to a reduction in A&E attendances by 13% and emergency hospital admissions by 9.7% in the local system. This reduced demand coupled with the hospital reconfiguration will create greater capacity in the specialist emergency hospital. Ambulances will therefore not be subject to the same delays currently being experienced for handing patients over to the hospital staff.
Detailed modelling based on future predicted population estimates has been undertaken to look at the required number of beds at the specialist emergency hospital to serve the whole population of mid and south Essex. However, the NHS does have detailed escalation procedures when a hospital’s capacity is challenged for any reason.

In developing the proposals for the hospital reconfiguration, detailed work has been undertaken to map “blue light” travel times between the three hospitals at both peak and non-peak times. For all of the proposed service configurations 100% of “blue light” journeys could be undertaken within 45 minutes.

There is a dedicated Transport Project Team which is undertaking a further piece of work on public and patient transport. In addition there is also a review of the wider strategic plans for the road infrastructure as part of the Essex Traffic Management Strategy.
Under the proposed hospital reconfiguration, over 90% of all patients would still be going to their local hospital. This includes all day cases, walk-in A&E cases, outpatients and the majority (66%) of visits for reconfigured services. Each local hospital will also have beds for a short stay for observation and recovery.
Once a patient has received their specialist care at the relevant specialist hospital, they will be transferred back to their local hospital at the earliest opportunity. This will minimise the amount of time relatives and friends will have to make the longer journey.

The Transport Project Team will be considering a wide range of possible options to support patients and their relatives travelling to each of the hospital sites, including subsidised public transport.
No decisions have yet been taken about which option will be recommended for the reconfiguration of hospital services across mid and south Essex. This proposal would then be subject to a public consultation. Until there is clarity on the exact configuration of services across the three hospitals it is difficult to develop detailed major incident plans. However, it is recognised that there are significant statutory obligations in this area and robust plans will be in place once a final configuration is determined.
We would also like to clarify that no decisions have yet been taken to move trauma and orthopaedics from Southend to Basildon Hospital and I would like to reassure you that there are no plans to close the Southend A&E department and all options being considered include 24/7 services remaining on all three hospital sites.
The health and care system in mid and south Essex faces a number of challenges, including rising demand and workforce recruitment difficulties across this system, which are contributing to the issues you describe.
Since April last year, clinicians have been working together to develop plans for how the three main hospitals could meet rising demands by working better together as a group, including ways to provide major emergency care and create more space for planned surgery. This also included a work stream looking at the ambulance service. This work has helped to inform the options for reconfiguration of the three hospitals in mid and south Essex, which are outlined in the STP.
The STP describes a network of services that could greatly improve emergency care for people in Southend and all across mid and south Essex. The main principles of the emergency care network are:

  • To improve information and education so that people know more about how to avoid accidents and stay well e.g. help to avoid falls
  • To do more in terms of prevention and early intervention e.g. proactive and personalised care to help people with health risks avoid serious illness
  • More services locally to act quickly in an emergency e.g. rapid response teams and mental health crisis teams
  • Easier access to urgent care with improved 111 and out of hours services
  • Further developments in ambulance response teams to treat people at the scene and avoid the need for a transfer to hospital
  • Emergency services at all three hospitals, not just for minor injuries, but to be able to manage the majority of emergency cases, supported by assessment units for older and frail people, children and people who may need surgery
  • A specialist emergency hospital for all 1.2 million residents of mid and south Essex that has the right level of highly trained specialists to provide the best possible life-saving care, 24 hours a day

A recent options appraisal of the proposals for the configuration of the three hospitals has been undertaken to narrow down the options for further consideration. However, we have been reassured that no decision has been made and that this does not rule out other options at this stage. Any proposals for service change will be subject to a public consultation by NHS England later in the year.
I hope that you find this response useful. We would like to reassure you that the Council will only be supporting proposals which lead to improvements in health outcomes for Southend residents. We would also urge you to submit your comments on the impact of the proposals by contacting:<>
Kim Vann
Executive Assistant to Simon Leftley – Acting Chief Executive and Andrea Atherton – Director of Public Health
Southend Borough Council

Response by the local Ambulance Trust employee

Dear Kim Vann

Thank you for your detailed and thorough response on behalf of Councillor Folkard.

As far as I can tell. The reasons given for the proposal are that:
A: difficult to recruit/retain staff at downgrade locations. And…
B: demand for services is going up.

The rationale makes no sense.

On the one hand you are saying that it will be easier to retain “specialist” staff if we have one place to put them all?
Rather than say, invest in them and increase the services that they provide locally, which is not mentioned as either a realistic alternative or an example of why it would be a bad idea.
Bear in mind that these staff and services are the ones caring for the most sick patients, we are told that by moving them further away from patients (no other reason offered) the quality of care/outcomes will improve?

And on ‘B’ you are talking about restructuring local services and educating the public in order for them to need Hospital less.
Well ok, but that’s got zero to do with acutely injured or ill patients. And even if it did, the proposal talks on the one hand about studies showing improved outcomes for patients when seen in specialist centres, I agree but that doesn’t preclude every DGH from having every specialist service within its walls it just makes the case that heart attacks should be seen by cardiologists with access to a cath lab; and then talking about maintaining services for locals who will be educated to need them less and have community options offered instead. These would be the non time critical patients whom, it might be argued, could afford to travel the extra 10km for a hospital bed.

On the issue of travel times, the whole 45 minute thing, for the ambulance service at least, is a measure of decision making.
If I have a major trauma positive patient in my ambulance, the definitive place of care for them is currently Royal London because that’s the closest MTC. If the journey is calculated to be less than 45 minutes AND the patient is clinically stable then that’s where we go. If we cannot control bleeding, the patients GCS is dropping, they are de-saturating, the affected limb is compartmenting, the airway is unstable etc, then we would go to Southend and pre-alert with a trauma call. They would stabilise the patient prior to a blue light transfer onward to Royal London later.
Same with an MI that develops into a cardiac arrest. Stop at Southend to stabilise before going on to PPCI.
Same with uncontrolled seizures from a cerebral insult before going on to Queens Romford. Etc.

Whilst it may be that investment into community led health services and smarter GP utility returns an overall decrease in hospital admissions and shorter stays; the founding principal of post-Napoleonic triage is that we put the greatest effort into treating those with the greatest need first.

The STP proposal however sounds like prehospital closure planning, smells like privatisation potential, looks like costs matter more than lives and tastes like a vanity project with a possible OBE for the architect.

There is no mention of a staged investment in community services in order to measure success prior to downgrading DGH services. I put it to you that this has more to do with an expected election cycle than belief in either a strong and stable government or long term accountability in health care provision management.

And as a local voter, I urge you to make the case that Southend would be better served with an increased level of ‘specialist’ care within the bourough than without.


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