Hundreds of patients in Dorset ‘at risk of dying under NHS cuts’ Poole’s A&E, maternity and paediatric services will be lost to Bournemouth Hospital, which will be the area’s main emergency unit.

Hundreds of patients – including new born babies – are at risk of dying or being left disabled under plans to downgrade A&E and close maternity services at Poole Hospital as Health Secretary Matt Hancock is yet to decide whether to step in and refer the cuts to an independent panel.

Poole’s A&E, maternity and paediatric services will be lost to Bournemouth Hospital 12 miles away, which will become the area’s main emergency hospital, under Dorset Clinical Commissioning Group (CCG) plans. Poole is set to become a centre for planned treatment and operations.

A South West Ambulance Trust report – commissioned by the CCG itself – shows plans to downgrade Poole A&E and close maternity services will put at least 396 Dorset emergency ambulance patients per year at risk of “potential harm” – with almost 200 of those at serious risk including death.

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Hospitals in Shropshire, Somerset, Huddersfield, Kent and Perth are also among those facing closure, downgrading or merging of emergency services as the NHS tries to plug a potential £22bn black hole in funding.

Dorset CCG’s plans mean that maternity care for deliveries under 32 weeks, and intensive and high dependency newborn care, will only be available at Bournemouth Hospital, in the far east of Dorset, for the whole county – out of safe reach campaigners say. Many patients face long emergency journeys, beyond safe guidelines, if Poole trauma A&E is lost, they add.

Critical cases

The report modelled various critical cases to see the affect of emergency patients travelling up to 23 extra minutes in an ambulance. They include an unresponsive child who would have faced a nine minute longer journey, a mum-to-be with ectopic pregnancy in extreme pain with internal bleeding and potentially fatal low blood pressure, who would have faced a 19 minute longer journey, and a 75-year-old with sepsis who faced an extra 23 minutes journey.

Some of the patients would have died on route anyway, but a Dorset A&E doctor who analysed the report said that just under half were in imminent danger of dying, so that any longer journey was likely to prove fatal. Using the figures for the four-month period analysed in the ambulance trust’s report, this works out to 183 potential extra deaths per year.

Last month, members of Dorset County Council’s health scrutiny committee wrote to Mr Hancock asking that he refer the plans to the Independent Reconfiguration Panel – the independent expert on the NHS – for full scrutiny.

They said that there was concern that ambulance travel times “have not been satisfactorily scrutinised and that the evidence needs further investigation to the current claim that these travel times will not cause loss of life”.

A second reason for referral was that there was “no local alternative to the loss of community hospitals given Dorset’s demographic with its ageing population and how that service will be delivered”.

Poole Council will vote on possible referral on Monday.

Legal battle

The merger of Bournemouth and Poole hospital trusts was first highlighted by i last year as part of an investigation into wide-ranging NHS cuts. Plans to reconfigure acute services were boosted in September after a judicial review was dismissed by a High Court judge. Campaigners are waiting for leave to appeal the decision. Some 37,000 people have signed four petitions asking the CCG to keep Poole Hospital A&E and maternity departments open.

Defend Dorset NHS wrote to Mr Hancock this week stating that Dorset CCG has not done the work that the ambulance trust calls for in their report to assess the extent of the “potential harm” to the 396 patients.

“Dorset CCG themselves provided the evidence to the High Court that 132 emergency ambulance patients over the four months of the Ambulance Trust Report, or 396 patients over a year, would be at potential harm,” the letter states.

Debby Monkhouse, from the campaign group, told i: “For many critically ill patients, travel time to hospital is of the essence. For heart attacks, every minute of delay results in loss of heart muscle. For strokes, there is a fixed treatment window. For sepsis, every hour delay results in an increase in mortality.

“Despite ongoing written opposition from tens of thousands of residents, from eight local authorities from Parish to District and Borough Councils the Dorset Clinical Commissioning Group continues to push forward with these dangerous plans.”

CCG report

On Thursday, Dorset CCG published findings of its “expert review of 34 cases by Dorset’s most senior doctors and paramedics” which concluded that increased travel times by ambulance would not have changed the outcomes for these patients at potentially higher risk.

The CCG’s chair Dr Forbes Watson said: “We have known all along that the most important factors are getting ambulances on the scene quickly for the most serious of cases and then getting patient to the most appropriate facilities with specialist staff, even if this means travelling past the nearest hospital. This review by some of Dorset’s most senior clinicians has reaffirmed this fact.

“There are inaccuracies being circulated and I would encourage anyone who wants to find out the facts and be assured these changes are the best thing for people in Dorset to read the report and make up their own mind.”

However, the A&E consultant who made the initial assessment that almost half of the patients in the ambulance trusts’s report were in imminent danger of dying disagreed with the findings.

They said: “Ambulances cannot ventilate a live patient as they do not have an anaesthetist on board, nor can they give anitibiotics for sepsis, where every hour delay in treatment increase the risk of death by 7.6 per cent, nor can they give blood if there is a haemorrahage.

“For example, looking at the child cases in the review, three are unconscious, which means they cannot support their airways, and, although the Ambulance can give oxygen they cannot effectively remove carbon dioxide. This leads to the child’s blood becoming acidotic, which affects the ability of the heart to work, and the child could then go into cardiac arrest within minutes.”

Campaigners are also concerned that the sample does not include the Dorset residents who will have the longest journey times under the plans.

Minutes matter

Dr Tony O’Sullivan, co-chair of Keep Our NHS Public and retired paediatrician, said: “Minutes’ delay accessing treatment can be critical in so many scenarios. Government policy driving Dorset CCG’s closure plans under a screen of specialisation is mistaken – delayed access can kill sick children, maternity emergencies, patients haemorrhaging or septic.

“Dorset CCG’s published clinical review of the concerns raised by the ambulance report dismisses risks from travel times. These were real life and death scenarios and must not be ignored. The report confirms in at least 10 of 27 cases, patients were indeed at risk of ‘potential harm’, but the outcome showed no actual harm or the patient would have died anyway.

“This sample does not negate the potential for fatalities from longer journey times, a finding backed by published research. Matt Hancock has a duty to ensure these avoidable, life-threatening risks are examined. That is the job the Independent Reconfiguration Panel not Mr Hancock’s office.”

A DHSC spokesperson said: “We want patients to receive world-class care in world-class facilities and any changes to local NHS services are rightly designed by local experts who know their patients best.

The department is considering the case and would respond to the council “in due course”.