Reconfiguration is not always just about money
Posted on 28 September 2012 by Zoe Greaves
I come originally from Kendal on the edge of the Lake District, a small town with a small hospital called Westmorland General.
When I was a child, Westmorland General had a small but busy emergency department. By the time I moved away, this had been replaced by a small and perhaps busier minor Injuries unit. Now there is a primary care assessment unit.
For people living in the heart of the Lake District, this means an even longer commute in times of emergency.
I put myself back in the position of the local girl of eight years ago, and I can feel the indignation that my town has been so abandoned. For what reason? Is it just about money?
Stepping back to the present, money seems the least important issue. Patient safety comes first.
You see, the presence of a small emergency department is not enough on its own to save a life. The emergency department does not exist in isolation; it is that small tip of the iceberg that floats above the water.
If you have waited at your local emergency department only to find that the urgently required CT or MRI is not available, that your stroke cannot be thrombolysed, that your emergency surgery cannot be carried out, or that any one of a myriad of other urgently required interventions cannot be performed on site, then it is precious hours that have been wasted.
The Mail on Sunday’s Stop the Casualty Closures campaign suggests that ‘the proportion of patients who will die rises 20 per cent for every extra seven miles they have to travel to get to [emergency medicine]’.
That is a phenomenal statistic, but I would be interested to know the mortality of patients who waited two hours to be seen in one emergency department only to be sent on for treatment at a different hospital 30 miles further away.
My second concern regarding rural hospitals is perhaps more selfish.
It grieves me to say it, but as a junior doctor seeking to gain the best possible experience, hospitals like Westmorland General are where junior-doctor dreams go to die.
Interesting or challenging cases go straight to larger hospitals, and juniors are used for service provision. It is only thanks to the GMC (www.gmc-uk.org), and not the clinical demand, that there is anyone above SHO grade present out of hours.
My final concern, yes, is financial.
Resources are not infinite; nor are doctors’ abilities. In an ideal world, we could have large tertiary centres positioned at 30-mile intervals across the country.
But even then you would hit an obstacle: as a population, we are just not that sick.
You see, not only do doctors need to be resourced when it comes to equipment; we also need to be resourced by patients. We need to see a certain number of a type of illness in order to maintain our competence in managing it; if the population is too small, the medical workforce becomes deskilled.
I can understand the fears of smaller communities about increased journey times for emergency medical care. But I would caution people not to assume that this is all about money, and ask that we all consider the bigger picture, and the wider challenges associated with delivering safe and effective emergency care.
Zoe Greaves is a South Tees foundation year 2