PlayState of Emergency
Published: Monday, 29 October 2007, 12:45PM
Hospital emergency departments are busier than ever, yet many are facing closure with some estimates suggesting nearly half the country’s units could be downgraded or shut in the future.
The NHS wants to create larger, specialised casualties, which medical evidence suggests may be better equipped to save lives in some serious cases.
But as the Tonight team discovers, the policy could have a detrimental impact on both the ambulance service and a large number of Britons who suffer from conditions that need aggressive intervention in a matter of minutes, such as epilepsy, respiratory illnesses and allergic reactions.
Clare Forbes, 22, contracted meningitis six years ago. She developed severe septicaemia and unfortunately had to have both legs amputated below the knee. But Clare believes that the four-minute ambulance ride to Crawley A&E saved her life.
Clare tells Tonight: “…if you’ve got any illness like mine you’d never be able to make it up to different hospitals further away. Four minutes I think was just the right amount of time for me to get to a hospital. If it was any longer then I wouldn’t have made it.”
The Crawley casualty, however, has since closed and two more units in Clare’s local area also face a similar fate. A major public consultation is currently being carried out on a plan to create one major specialist unit instead. The Trust argues that this will help patients and that the slack will be taken up by Urgent Care Centres, a new super hospital and A&E hospitals outside the area.
In the Tonight programme, Clare relives the ambulance journey taken six years ago to see what impact the changes might have. The team takes her to the next nearest unit in East Surrey Hospital in Redhill. The journey takes 31 minutes but the ambulance driver estimates that it would take at least 15 minutes using blue lights.
The programme also follows the case of Jack Heath. The eight-year-old suffers from Hunter syndrome, a genetic disorder that can cause respiratory problems, and relies on emergency care to be close at hand.
At the moment, the journey time from the family home in Bacup to Rochdale Infirmary is around 14 minutes. But the Secretary of State for Health, Alan Johnson, recently approved the closure of Rochdale A&E, which is only five years old. The A&E unit is to be replaced by an urgent care centre.
In an emergency, Jack will now have to travel to Oldham Royal Infirmary, which is 28 minutes away. His family believe that he could die before ever reaching the hospital.
According to a recent independent review of the NHS carried out by Sir Derek Wanless, attendances at A&E have increased by a third since 2002. Professor Steve Goodacre of the University of Sheffield this summer published a study that found the risk of death for people who are unconscious, not breathing or have chest pain rose by 1% for every 10km (6.2 miles) travelled.
The NHS has also pledged to invest more money into ambulance service equipment and personnel to allow them to resolve more problems on the scene and take some of the pressure off emergency departments.
But a Tonight with Trevor McDonald investigation earlier this year showed that it will have a big job on its hands as just half of British ambulance staff are fully qualified paramedics and can give a more sophisticated level of on-the-spot treatment.
Expert Dr Jim Wardrope, president of the College of Emergency Medicine, tells Tonight that bigger specialist hospitals don't necessarily mean better outcomes for all patients.
And Jonathan Fox, a paramedic with the Association of Professional Ambulance Personnel, says there could be other detrimental side-affects from longer ambulance journeys.
He explains that even with paramedics able to do more for patients, getting “time critical” seriously ill people to A&E fast remains essential.