Threat looms for night-time A&E

HINCHINGBROOKE Hospital looks set to scale down its night-time emergency service, possibly offering only minor injury treatment between midnight and 8am, in a bid to save money. Instead, people with major injuries – other than head injuries which, as now,

HINCHINGBROOKE Hospital looks set to scale down its night-time emergency service, possibly offering only minor injury treatment between midnight and 8am, in a bid to save money.

Instead, people with major injuries - other than head injuries which, as now, would go to Addenbrooke's in Cambridge - might be taken straight to Cambridge or Peterborough.

Or they might be taken to Hinchingbrooke, as now, for clinical decisions to be made about where, if anywhere, to send them for immediate treatment after stabilisation.

Patients needing intensive or coronary care or resuscitation would still be admitted to Hinchingbrooke, whatever the final decision.

Of the four options two have been ruled out - change nothing and provide nothing other than GP out of hours treatment. Two remain but no decision has yet been taken.

They are a nurse-led service and a minor injury and clinical decision unit to assess patients and stabilise them before moving them elsewhere if necessary. The latter will have less impact and is believed to be the favoured option.

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In either case, intensive care and emergency coronary care beds would be retained for patients taken seriously ill in the night.

The scale-down would apply to injury and major trauma. But the hospital stresses that an average of only 10 patients are treated in A&E overnight and many of those have only minor injuries. But there would be savings in not having fully-staffed orthopaedic teams, for example, on duty in case they are needed.

Scaling down of A&E is one of the many reviews going on that have fuelled the Hinchingbrooke rumour-machine, which is working overtime to conjure all manner of doomsday scenarios. In the face of that the hospital's managers this week moved to reassure staff and patients (Open letter on Page 1).

The crisis stems from Department of Health demands that the hospital trust not only breaks even month-by-month but that it also repays a £6.5million deficit on its £70million-plus budget by next April. The trust aims to reduce paybill costs by 10 per cent - £5.1million - and save a further £1.9million on other spending. The trust also plays in a target of £2.6million additional income, making a total savings target of £9.6million.

This has led to the likelihood of up to 200 compulsory redundancies on top of money-saving changes in the way the hospital operates. It is uncertainty about the outcome of those reviews and their impact on patient services that have fuelled the speculation.

But the ambulance service said whatever decision Hinchingbrooke took could stretch resources to the extent that the current level of cover could not continue to be provided in Huntingdonshire without deploying additional vehicles and crews overnight.

"Crews would be more likely to be in Cambridge or Peterborough when emergency calls came through, so cover would be improved there at the expense of Huntingdonshire," a spokesman for the East of England Ambulance Service said.

"But, if the clinical decision unit were retained, there would be likely to be a very small percentage of calls diverted away from Hinchingbrooke.

"But, if we had to invest in more vehicles and crews, we would ask the primary care trust to fund the additional cost. Whether we need to would depend on what Hinchingbrooke decides to retain - and we don't know that yet."

Huntingdon MP Jonathan Djanogly, who recently met senior managers to discuss the hospital's plight, believes a combination of over-optimism by managers and central Government health polices are to blame.

"It's clearly not a happy situation there," he said. "It's not clear whether it's a local fault of that of national Government probably a bit of both.

"They are having to manage it very harshly now to live within their means. It's difficult to tell the extent to which it will impact on patient services."

Mr Djanogly said the hospital trust had clearly under-estimated the demand for services at the new £25million treatment centre, which opened last September, to cope with the 80 per cent of operations that are dealt with as day cases, but which is running at just 70 per cent capacity.

The MP had also received assurances that constituents worried that they would not be allowed to stay for more than one night if they needed to and from female patients concerned that they would be in mixed wards.

"The threat to A&E was simply denied by the hospital," he said. "The intention is not to close it at all, though they will manage access to certain specialities by having people on call rather than in the hospital.

"They have a problem and they're acting on it by managing it rather than putting it off. But I can't think anything will get easier with the new primary care trust (covering the whole of Cambridgeshire and taking over in October). We must be concerned for local facilities."

The Liberal Democrats are blaming Whitehall for Hinchingbrooke's plight.

Lead member for health, County Councillor Geoff Heathcock, said: "This, sadly, is another example of the NHS in very real trouble with the often bizarre ways in which resources are allocated which, together with so much change, is causing real stability issues in the service".

The British Association for Emergency Medicine (BAEM) claimed the scaling back of casualty departments in various parts of the country was being used to bail the NHS out of its cash problems.

United Lincolnshire NHS Trust is looking at whether the local Grantham and Skegness hospitals should lose their A&E units, and in Burnley, Lancashire, reducing A&E services in the area is also being considered.

BAEM president Martin Shalley said: "As well as leaving some patients miles from essential services, these plans are putting too much strain on nearby hospitals. The motive is to save money and that is not right.

"A&E is an easy target as it is relatively expensive and the running costs are hard to predict because you do not know how many patients need to be treated.

"If we keep stripping these services, we will put patients at risk.