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Last Updated: Friday, 1 December 2006, 08:42 GMT
Turbulent times for emergency care
By Adam Brimelow
BBC News, health correspondent

Medical equipment
Specialist services are being centralised
The Conservatives have demanded a fresh start in the process of reforming emergency services in England.

In a letter to the health service's chief executive, Andrew Lansley, the shadow health secretary, has questioned the evidence for the proposed changes.

They would see services concentrated in big regional centres, while local A&E units are downgraded or closed.

He has identified 29 A&E units which are under threat.

Mr Lansley said the exercise was being driven by the need to save money. But the government said it will make services safer and more up-to-date.

Can these changes can ever be delivered without provoking local fury?

I think we'd be better off living on one of the Scottish islands
Joss Mahon

It is more than five years since Richard Taylor shook the political establishment by leading a revolt in Kidderminster over the closure of hospital services, including the A&E.

His election showed just how politically sensitive these decisions can be.

Now emergency services across England are being overhauled. Richard Taylor is worried that important lessons have been forgotten.

He said: "Everybody will travel for high-powered difficult surgery, difficult cancer-care, major trauma.

"But they want on their doorstep facilities to see a doctor who can cope with the bread and butter, run of the mill emergencies, which are usually medical things.

"The heart attacks, the strokes the pneumonias, which come out of the blue without any warning."

Acceptable compromise

He said it is about finding an acceptable compromise. He thinks it can be done, and he gives the example of Hexham in Northumberland.

There is a growing range of skills that paramedics have that are enabling treatment to take place either in peoples' homes, or at the roadside
Darrell Jackson
Community paramedic

The Emergency Care Unit in Hexham general hospital has doctor-led care round the clock, backed up by experienced, highly trained nurses.

It is all pristine and new, with ten beds off a central corridor, resuscitation rooms at one end, minor injuries at the other.

It is part of a 28 million PFI scheme, that replaced the old World War Two Nissan huts.

The hospital serves a small largely-rural population. Places much bigger than this are in danger of losing their A&E, so how does Hexham manage?

Dr Chris Townsend-Rose is the senior doctor in charge here.

"It is a very small hospital and if it was trying to stand alone it wouldn't be viable.

"It survives because it's part of a much bigger trust. We have two bigger sister general hospitals not too far away."

That means it can rota in senior doctors from other hospitals, while the nurses here take on tasks previously carried out by with junior doctors.

Bigger role

Darrell Jackson, a community paramedic with the north east ambulance service, said they were also taking on a bigger role.

"There is a growing range of skills that paramedics have that are enabling treatment to take place either in peoples' homes, or at the roadside.

"A good example is chest decompression. We can now do that. It avoids the problems of a collapsed lung for a patient which is life-threatening.

"Previously, we either have to call a doctor out to put a chest drain in, or we'd have to try and get the patient to the hospital as fast as we could so that they go to surgery for a drain to be fitted."

So, emergency care is changing, but not everyone here is happy about it.

Three-and-a-half years ago Joss Mahon broke her elbow after coming off a bike. She had an emergency operation in Hexham.

Two years later she fell off a horse and broke her other arm.

Hexham hospital no longer carried out emergency surgery, so she was transferred on to Ashington in north Tyneside.

"I think we'd be better off living on one of the Scottish islands I know, where they take you up in a helicopter, it's a lot quicker. It's just ridiculous to have to travel so far."

For Joss, it meant a round trip of more than 100 miles for treatment.

Lives at risk

Another big concern here, and in many other rural areas, is that travelling further to the bigger hospitals may take too long, putting lives at risk.

But the government's emergency access tsar, Professor Sir George Alberti, said the longer trip is well worth it for the right specialist care.

"I have no trouble with that concept at all because for example if my aorta is beginning to rupture I want to see a vascular surgeon, who is experienced at doing that operation.

"Now if it takes 20 minutes longer to get there so be it. And the same goes now for heart attacks, for strokes, you need to be at a specialist unit."

He insisted the changes in emergency care are about improving safety, rather than saving money.

But the Conservatives have compiled of list of 29 hospitals where they say A&E services are under threat.

They say seven out of ten trusts proposing downgrades were in deficit last year, and conclude that the process is being financially driven.

They have called for a fresh start to the process, with open consultations that point out where optimum services can't be paid for or staffed.


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