27 nov 2013
The ultimate indignity of the A&E closures: The hospital where
the NHS was born is losing its casualty ward but not a penny of the £12m
promised to help a nearby unit cope with the extra patients has arrived
The hospital where the NHS began
will lose its A&E department this week – and campaigners fear its
closure will lead to a ‘chaotic and worrying’ winter for patients.
General Hospital, where Health Minister Aneurin Bevan officially
launched the NHS in 1948, will shut its 24-hour A&E on Wednesday.
About 8,500 seriously ill or injured patients will have to be dealt with
by Manchester’s other busy hospitals each year.
behind the reorganisation, dubbed the New Health Deal For Trafford,
describe it as ‘a blueprint’ for hospital care across the country.
The hospital where the NHS began will lose its
A&E department this week and campaigners fear its closure will lead
to a 'chaotic and worrying' winter for patients
But The Mail on Sunday has discovered
that a £12 million plan to enlarge neighbouring Wythenshawe A&E so
it can cope with the expected surge in numbers has barely got off the
ground. Not a penny has yet arrived.
councillor and A&E campaigner Jo Harding said: ‘We are potentially
heading to a very chaotic and worrying winter. These extra resources are
not only to cope with Trafford A&E closing, but also due to the
fact that Wythenshawe is already overcrowded.’
said last winter’s A&E waiting time figures for the South
Manchester hospital, eight miles from Trafford, were ‘incredibly
NHS bosses had been unable to guarantee it would cope better in the coming months.
‘Why close Trafford A&E right now, when the NHS is predicted to have one of the worst winters ever?’ she asked.
A&E is expected to bear the brunt of the closure, with almost 5,000
more patients a year predicted. Ministers were first warned of the
urgent need to upgrade Wythenshawe’s A&E if Trafford’s closed, two
Last December, hospital
bosses submitted a bid to the Department of Health for £12 million extra
funding, warning that the ‘planned closure’ meant that ‘further A&E
pressure is likely’.
the last year they have also been warning A&E overcrowding is a
‘significant risk’. But the Department of Health has only recently
agreed to the cash injection – and it will be next April before a
planning application for the upgrade is submitted.
Ministers were first warned of the urgent need to upgrade Wythenshawe's A&E (pictured) if Trafford's closed, two years ago
Labour MP Kate Green, whose
constituency includes Trafford General, last night criticised how long
it had taken to get the £12 million approved.
and neighbouring MP Paul Goggins had been trying to raise the issue
with Ministers ‘ever since these proposals first appeared in 2011’, said
Ms Green, first with Andrew Lansley and then Jeremy Hunt, who replaced
him as Health Secretary.
had a long time to work this out – they should have got on with it,’
she said. ‘The timing of this closure is very worrying, particularly as
we head into an uncertain winter season.’
Hunt rubber-stamped the closure plan this July. It will see Trafford’s
A&E downgraded to a consultant-led Urgent Care Centre, open 12 hours
will also lose intensive care and acute surgery, so patients such as
those with suspected broken hips, severe abdominal pain, or the acutely
ill, will have to go elsewhere.
Trafford will lose all its emergency facilities bar a nurse-led unit
for minor problems, meaning tens of thousands more will be pushed into
Manchester’s other hospitals.
BEVAN'S GIRL: THE HEALTH MINISTER'S FIRST NHS PATIENT, A 13-YEAR-OLD GIRL WITH A LIVER CONDITION
July 5, 1948, Health Minister Aneurin Bevan visited Park Hospital in
Davyhulme, Manchester – later renamed Trafford General – to accept the
keys in a symbolic ceremony to launch the NHS.
he spoke to Sylvia Beckingham, a 13-year-old girl with a liver
condition, who became the first person to be treated under the National
Aneurin Bevan (second left) talking to the NHS' first patient Sylvia Diggory, 13, at Trafford General
Bevan, a coal miner’s son who
had fought hard to establish the NHS against bitter opposition, told her
that the birth of the service was ‘a milestone in history – the most
civilised step any country has ever taken’.
On that day, the NHS took control of hundreds of hospitals across England and Wales, containing 480,000 beds.
Ms Green said nobody could ‘rely on
history’ to keep Trafford’s A&E open. But she added: ‘The loss is
symbolic and people are anxious history should be recognised and
high-quality medical facilities should remain on the site.’
week, The Mail on Sunday revealed how A&E waiting times at Slough’s
Wexham Park Hospital soared last winter, after bosses failed to spend
£2.5 million earmarked to upgrade the department in light of a nearby
But doctors behind
the Manchester changes insist they are for the best. Dr George Kissen,
Trafford’s clinical director, said the hospital was ‘too small to be
able to guarantee quality in the future’.
serves just 100,000 people – a quarter the recommended catchment for a
district general – and its A&E is one of the smallest in the
Ebbing away: Britain's A&E doctors are quitting for Down Under
The ‘vision’ for South Manchester is
to create what NHS managers call an ‘integrated care system’, keeping
more patients out of A&E by boosting GP surgeries and care in
emergency doctors and nurses will be redeployed in Manchester’s other
hospitals, raising staffing levels, particularly at nights and weekends.
Trafford will specialise in diagnostics, outpatient appointments and
pre-planned operations, with the hope it will become a ‘centre of
excellence’ for orthopaedic surgery.Medical director Dr Bob Pearson
said: ‘Trafford General Hospital is a blueprint for the new model of
local hospital care proposed nationally.
now has a secure and viable future and services can continue to be
provided safely and to a high standard.’ A Wythenshawe hospital
spokesman said 13 more patients were expected to attend its A&E
every day as a result of ‘imminent changes’ at Trafford, or 4,745 a
She said the
£12 million funding would ‘deliver additional ward capacity, increase
the number of resuscitation bays and address the overall capacity of the
department’, but added: ‘The scheme is still within the initial
planning stages and will be a two-year programme.’
Department of Health spokesman said: ‘There is clear clinical evidence
that the changes to Trafford A&E, one of the smallest and least
attended in the country, will benefit patients in the long term.’
Meanwhile, managers are playing 'video game' to help make cuts
bosses are playing The Sims-style computer games to help them
redesign A&E departments – but campaigners fear the virtual-reality
software could be used to justify cuts to services.
NHS managers are using the technology to predict the impact on patients of reorganising wards or numbers of staff.
Sick Sims: Scenes from the 'virtual-reality' software being used to reorganise hospital A&E departments
Computer modelling firm Simudyne created the 3D A&E simulation to represent how doctors, nurses and patients interact.
company says it also helps organisations plan for nightmare scenarios
such as buildings being blown up or cargo ships sinking.
Lyon, chief executive of Simudyne, argued that virtual reality should be
at the forefront of planning when hospital services are changed.
lives are fundamentally changed by these decisions,’ he said. ‘We
should be testing them in a simulated environment. After all, if you
kill an avatar, you just hit the Restart button.’
Dr Onkar Sahota, chairman of the Save Ealing Hospital campaign, warned:
‘What happens in reality can be totally different to what a model
He said A&Es
are hard to predict as viruses, the weather and other random factors
often drive demand. ‘You need to have capacity to respond if the
unpredictable happens,’ he added.
Mr Lyon has been working with Watford General Hospital to improve its
A&E, allowing managers to predict the impact of changing factors
like staffing rotas.
Last month, doctors had to turn away ambulance patients because the department was so crowded.
Modelling identified ‘a potential bottleneck as patients exit A&E and go on to the wards’, he said.
A Watford hospital spokesman declined to comment.
How we have lost 1 in 4 vital A&E staff... to Australia
Almost one in four young A&E
doctors who trained in Britain have left to work in Australia or New
Zealand, amid fears of a growing staff shortage in emergency care.
warn the mass exodus of junior and middle-grade doctors, which has
gathered pace in recent years, threatens the future of the A&E
It is not only the
beaches and blue skies that attract our highly skilled medics, who cost
hundreds of thousands of pounds to train. They are also being drawn by
better working conditions and higher pay.
A JUNIOR DOCTOR ON WHY HE'S LEF THE UK: 'I'VE HAD ENOUGH OF LEAVING THE SICK TO WAIT IN CORRIDORS'
I qualified seven years ago and arrived in Australia specifically wanting to work in emergency. Why did I come here?
In England, there would regularly be queues in the corridors. That’s stressful and limits the skills you develop.
of that pressure, and a target to get patients out of the department
in four hours, I’d sometimes refer patients to a specialist without even
seeing them, knowing they had a given problem.
But this has huge failings: incomplete assessment of the patient, and significantly less experience for me.
Australian emergency departments seem to be under less strain.
you get to do more of those ‘specialist’ procedures yourself, so you
become a more competent and complete doctor. In the NHS, I’d work a
94-hour fortnight, which can leave you with a permanent feeling of
Here it’s a strict 80-hour fortnight and shifts are more flexible.
Australia pays significantly more, plus you get compensated for those anti-social hours and overtime.
short, for someone who loves emergency medicine, life here is better
balanced, better paid, and will make me a much better doctor.
I plan to return to the UK one day. I love the job there, but the stresses are huge.
Nearly 500 sub-consultant grade
A&E doctors who undertook basic medical training in Britain or
Ireland are now working in Australia or New Zealand.
The number has nearly doubled since 2008, said Dr Andrew Gosbell of the Australasian College for Emergency Medicine.
It means there are only about 1,800 A&E doctors of that grade now working in the UK.
departments in Britain face a critical shortage of A&E doctors,
with up to half of advertised junior posts remaining unfilled.
British College of Emergency Medicine has calculated there is now a
shortfall of 368 A&E registrars – almost two per department.
Dr Cliff Mann, its president, said: ‘We need to make coming home a more attractive option.’
While some just go for a year or two’s experience, he said: ‘The longer they stay, the more likely they are to set down roots.’
cannot match Australian A&E salaries, which he said are up to twice
NHS pay. But Dr Mann added: ‘Most people don’t emigrate for the money.’
claimed junior doctors’ training had suffered because consultants like
him ‘spend most of our time dealing with the large number of patients
coming through the doors’.
argued that A&E doctors fully expect to work many nights and
weekends, but anti-social hours should be recognised with more annual
Dr Mann warned that a
major long-term problem was developing, with the prospect of too few
senior A&E doctors to run departments in the future. ‘The problem is
there are rather fewer people like me coming through the system,’ he