The Issues

Lincolnshire Sustainability and Transformation Plan 2016

During May 2016 ULHT presented strategic plans (Lincolnshire Sustainability and Transformation Plan) for the delivery of acute medical services across Lincolnshire. The plans included the downgrade of Grantham Hospital Accident Emergency Unit & Boston Pilgrim A&E with future A&E services for Lincolnshire County Council to be centred on Lincoln Hospital which is struggling to cope with existing workloads and stretched to capacity.

 

In response to this proposal SOS Grantham Hospital started an online petition in line with a similar petition at Boston.

Grantham Hospital serves 120,000 people. It is located on the A1 East Midlands corridor north of Peterborough and on the East Coast mainline railway. The county of Lincolnshire is the fourth largest in the country and the next nearest A&E unit from Grantham is at least 23 miles away. The area has a diverse mixed rural and urban community with the residents and businesses of over 40 villages and 4 towns affected being Grantham, Newark, Sleaford and Melton Mowbray. The public transport network in the vicinity is poor with virtually no bus service running in the evenings and overnight. The area has a significant number of single parent households and low income households. Many have no car.

 

Short Term Overnight Closure of Grantham Hospital A&E between 18:30-09:00 Mon-Sunday inclusive

On 10 August, despite operational reports indicating issues with the East Midlands Ambulance Service and failures to meet targets at Lincoln Hospital A&E, ULHT stated they planned to close Grantham Hospital A&E overnight for ‘safety reasons’ arguing that there was an unsustainable shortage of medium grade A&E doctors across the Trust. The closure has resulted in local people being denied any access to A&E services and fails to reflect the vital life sustaining role Grantham A&E plays. The unit may provide emergency resuscitation and support critically ill patients until they are either admitted at Grantham Hospital or transferred elsewhere. Having stated the night time closure would be initially for 3 months ULHT have recently stated that the unit will be closed until at least February 2017.

This decision is putting lives at risk.

In August 2016 the United Lincolnshire Hospital Trust (ULHT) closed Grantham Hospital A&E from 18:30 to 09:00 every night at one week’s notice. The closure took place as local people wait to hear what long term strategic plans ULHT have for our hospital.

ULHT argue that the ‘temporary closure’, now extended until February 2017, was for safety reasons due to the shortage of medium grade doctors across the ULHT A&E units. In particular there were concerns that Lincoln Hospital was unable to cope with high levels of demand.

Local campaigners do not accept ULHTs proposals. We:

  1. Dispute the statement made by ULHT that the changes will provide better ‘patient safety’.

Residents and those working within the Grantham Hospital catchment area argue that under NHS Principals the needs of everyone should have been considered by ULHT. Local emergency medical needs have been ignored as significant delays in treatment may occur as a result of a reliance on an over stretched EMAS service at night due to non existent public transport and high taxi fares beyond the reach of many local householders.

  1. Argue that ULHT have deliberately misled key decision makers and the media in order to gain support for their night closure and downgrading of Grantham Hospital A&E

ULHT are publicly stating that:  ‘…people will see little change at Grantham Hospital if A&E was downgraded because emergency cases are sent to Lincoln, Boston and other hospitals.

SOS Grantham Hospital and other campaigners argue that this statement is totally misleading.

People in the Grantham area are at risk as a result of the night time closures.

The following conditions were treated at Grantham Hospital prior to closure at night.

Conditions treated at Grantham Hospital A&E
Serious heart attacks:

Patients who collapse and need resuscitation, ventilation and Advanced Life support

Problems with the brain and/or nervous system:

Meningitis

Encephalitis ( viral infection of the brain)

Guillain Barre syndrome (an acute paralysing illness)

Epilepsy and fits

Unconscious patients

Drug withdrawal

Alcohol withdrawal (eg the DT’s)

Delirium

Liver Encephalopathy ie delirium resulting from liver disease

Heart problems:

Heart attacks/Acute Coronary syndrome which are non STEMI ( ie do not require urgent coronary angiogram)

Atrial Fibrillation (fast irregular heart) and electrical cardioversion ( ie electric shock treatment to correct the heart)

SVT ( palpitations with fast heart rate)

Heart failure

Pulmonary oedema (excessive  fluid in the lungs causing difficulty breathing)

Infective Endocarditis ( infected heart )

Heart block causing sudden collapse

Conditions relating to lungs:

Acute asthma exacerbation/bronchitis

Acute COPD ( Chronic Obstructive Airway disease or smoke damaged lungs) including provision of  non invasive ventilation

Pneumonia

Pulmonary Embolism ( clots in the lung)

Lung Fibrosis with low oxygen

Lung cancer and its complications

Pleural Effusion ( fluid collection around the lung)

Liver:

Liver Cirrhosis and ascites ( fluid in the tummy)

Alcohol related emergencies

Hepatitis

Obstructed bile ducts with yellow jaundice and sepsis

Bowel:

Colitis and Crohns ( inflamed bowels with bleeding , pain and sepsis )

Acute Diverticulitis

Bowel Cancer and its complications eg. Fluid accumulation in the tummy

Blood Disorders :

Severe Anaemia requiring urgent transfusion

Anaphylaxis ie severe life threatening allergic reaction

Severe sepsis

Neutropenic ( low blood cells) with  sepsis in cancer patients who are not for suitable for intensive care

Sepsis in patients with blood disorders

Bleeding from being on Warfarin or other blood thinning treatment

Thrombosis – clots in the limbs

Kidneys:

Acute Kidney failure

Obstructed bladder

Complications of kidney failure such as life threatening high potassium, acidosis ( ie high acid in the blood), delirium, fluid overload and fluid in the lungs

Metabolic/Others:

Life threatening Diabetic complications eg. Very low sugar ( causing coma) or very high sugar with acid build up in blood ( eg. Ketoacidosis)

Liver failure

Kidney failure

Drug overdose

Very High or very low  potassium causing heart rhythm disorders

Very low or very high sodium, which can cause confusion, coma and  fits

Very high or very low calcium, which can cause confusion, fits and cramps of muscles

Collapse ?cause for investigation

Peripheral skeletal and joint problems:

Osteomyelitis ( bone infection usually with an ulcer)

Septic arthritis (pus in joints)

Fracture neck of femur ( hip fracture)

Falls and related injuries

Peripheral fractures

In nearly ALL instances serious conditions may be worsened or even fatal if not treated within a short time frame.

Independent evidence has identified that, especially where there are breathing problems, patients are at risk if there is a delay in treatment.

Furthermore during 2015/16 there were 4550 acutely ill patients who were treated at Grantham Hospital who arrived in a 999 ambulance. If ULHT comments were correct there would be no 999 ambulances arriving at Grantham Hospital A&E.

  1. ULHT state the closure is temporary but has set a 10 year level that it will apply before the unit is reopened at night time.
  1. ULHT has a poor track record in recruiting and retaining medical staff and whilst we recognise it is difficult to recruit in Lincolnshire ULHT have failed to come up with any initiatives that would address this issue despite being advised to by LCC Health Scrutiny Committee. Despite arguing there is an issue with recruitment they have failed to provide specific evidence relating to recruitment and the evidence that has been presented has highlighted very poor efforts were made to recruit.

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01476 574748

c/o 45 Harrowby Road, Grantham, Lincolnshire, NG31 9ED