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Author Topic: Shocking proof A&E closures cost lives: Death rate jumps more than a THIRD after  (Read 1096 times)


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Shocking proof A&E closures cost lives: Death rate jumps more than a THIRD after department closes

 •Health Minister orders investigation as Mail on Sunday uncovers rise
 •Data revealed under FOI rules show 37% rise in emergency patient deaths
 •Accident and Emergency in Newark, Notts, closed two years ago

By David Rose
PUBLISHED:21:59, 11 May 2013 | UPDATED:22:01, 11 May 2013
Comments (333)

The Mail on Sunday today reveals the first shocking evidence that hospital casualty department closures are costing hundreds of lives.
Official figures uncovered by this newspaper show a 37 per cent rise in death rates for emergency patients from Newark in Nottinghamshire, where the Accident and Emergency unit closed two years ago.
The figures, obtained under the Freedom of Information Act, come from the NHS trusts where Newark patients are now sent. They amount to the first authoritative study on what can happen when an A&E shuts.

Increase: The number of emergency patients dying since Newark A&E closed has risen by more than a third

Data: The Mail on Sunday obtained statistics on death rates from NHS Trusts
They show:
 •Of 5,441 Newark patients admitted for emergency treatment last year, 264 died – 4.85 per cent. Yet in 2009, when there were 5,431 emergency cases, just 192 patients died – 3.53 per cent. That was the year before NHS chiefs decided to close Newark A&E, promising ‘more lives being saved’. If the percentage rate had stayed the same after the closure, that would have meant 72 fewer deaths last year – in just one area, and in just one year.
 •When Newark had its own A&E  its death rate was lower than in nearby areas – despite the fact that the town has a higher than average elderly population. Now the Newark rate is higher.
 •Like other hospitals where A&Es close, Newark General now has only a so-called urgent care and minor injuries unit – banned from treating life-threatening conditions.
Having initially refused to investigate the MoS findings, health chiefs had a change of heart last night and, at 8pm, pledged to examine our evidence.

A spokesman for Health Secretary Jeremy Hunt said: ‘We always take changes in mortality data seriously and will look into the case in Newark in more detail.’

The U-turn came after doctors’ leaders said the data suggested the policy of axeing A&E units was placing lives in jeopardy. They called on Mr Hunt to order an immediate moratorium on further closures until more is known about their likely effects.
Their call was echoed by Tory MP Andrew Percy, a leading member of the Commons health committee.


 •Casualty chaos: 999 crews face £90m fines for waiting outside A&E with patients
 •111 helpline blamed for chaos in casualty: A&E patients 'dumped in corridors... and cupboards'
 •Shock 250% rise in patients waiting more than 4 hours in A&E: Six-month total soars by 146,000 - as Labour says crisis is worst in 20 years

Mr Percy said: ‘These shocking figures confirm what many local people already suspected. Shutting local A&E centres does not improve patients’ survival changes, it dramatically worsens them.
‘There should be no more such  closures until we have a thorough review of this policy.’

Mr Percy  said the closure policy was begun under Labour and ‘regrettably’ not reversed by the Coalition.
Even a former Coalition Health Minister said the closure programme should now be reviewed.
Liberal Democrat MP Paul Burstow, the former Care Services Minister, said: ‘I find these figures on death rates very worrying. ‘I do have misgivings ... it is now time to review the whole approach.’
Chairman of the Royal College of General Practitioners Dr Clare Gerada said yesterday: ‘The Newark data revealed by The Mail on Sunday points to a close association between A&E closures and mortality. It is clear the provision of emergency care is in crisis across the whole of the NHS.
‘Before any further closures are contemplated, there must be a full, independent assessment of their impact on patients and on the system as a whole.’



No answer: Jeremy Hunt refused to respond to questions from the MoS
The Mail on Sunday this weekend reports  the first official data detailing the impact on emergency care mortality rates when a local casualty unit closes. We asked Health Secretary Jeremy Hunt, left, the following questions:

1. Does he now accept this evidence that A&E closures can lead to greater mortality among emergency patients living in an area where a local casualty unit  has been closed?
2. Will he now order a moratorium on  34 pending A&E closures and downgrades until a nationwide  study has been completed?
3. If he still believes localised A&E closures are for the greater good, does he think higher death rates in areas where the closures happen are an acceptable price to pay? 
4. He and his government have previously insisted the A&E closure programme is localised NHS Trust policy and therefore nothing to do with the Government. Does he think the Government has ultimate responsibility for the nation’s healthcare? Will he now take responsibility for the programme? 
5. In Newark, the average time from 999 call to A&E handover is now more than two hours. Does he think this is acceptable?

Throughout yesterday Mr Hunt’s spokesman said the Health Secretary would not answer these questions as, she said, this newspaper had not established that Newark’s rising death rate was caused by the A&E closure – because the rise began in 2010, the previous year.
Yet the figures reveal admissions there were already falling. With the axe poised over the department, ambulances were being told to take serious cases elsewhere.

But at 8pm last night Mr Hunt’s department changed its position.

A spokesman said: ‘We always take changes in mortality data seriously and will look into the case in Newark in more detail.’
She added that a closure in one hospital was likely to worsen the pressure elsewhere. 
One consultant from North-West London, where five out of nine A&Es are set to be closed, said: ‘Newark tells us what happens when you close an A&E. As a frontline hospital consultant, these excess deaths are no surprise to me, and they clearly demonstrate the risk.’
The figures – which detail the number of patients who die within 30 days of admission to an A&E unit – have come to light in a week when Ministers have finally admitted that emergency provision nationally is in deep crisis.

There has been a doubling of the number of patients forced to wait more than four hours for treatment over the past 12 months.
David Prior, head of NHS watchdog the Care Quality Commission, has said the entire health system is ‘at the brink of collapse’ because of the pressure on A&E.
Yet in the face of this crisis, health chiefs are pressing ahead with an unprecedented programme of A&E closures and downgrades.
As this newspaper and its readers have been saying for the past 11 months, this is soon set to affect no fewer than 34 hospitals.
One of the most shocking aspects of the cuts is that there has never been any independent academic study of their potential impact.
This means the arguments made by supporters of the closures – that most patients will be better served by travelling to ‘superhospitals’, even if they face longer journeys – have to be taken largely on trust.

Deaths: The number of emergency patients who died jumped by more than a third after Newark A&E closed
There is evidence that some patients, such as stroke victims, are more likely to survive if taken immediately to major centres where they can receive specialist treatment, rather than an ordinary A&E. Indeed in Newark stroke death rates have declined slightly.
But other research, led by Professor Jon Nicholl of Sheffield University, has found that overall, mortality will increase with longer ambulance journeys.

Further FOI data shows the average time between a 999 call in Newark and transfer to A&E at King’s Mill Hospital, near Mansfield, or Lincoln Hospital is almost two hours. In ten per cent of cases it is nearly three hours.
These hospitals, where most Newark emergency cases now end up, are both more than 20 miles away, along roads which can be difficult even for an ambulance with a blue light.

Professor Nicholl said: ‘The research indicates there is a relationship between the distance to hospital and mortality.’

Investigation: Health Secretary Jeremy Hunt has promised to examine the Mail on Sunday's evidence
Dr Clive Peedell, a consultant oncologist who is also co-leader of campaign group the National Health Action Party and chairman of the NHS Consultants’ Association, said it was now evident that pressing ahead with further closures would be ‘disastrous’.
He said: ‘There is no evidence base to justify what they are doing. In A&E trauma cases, doctors talk of the “golden hour” for treatment when patients’ chances are maximised. If it’s taking nearly two hours to reach hospital, mortality is bound to increase.’
In the case of Newark, The Mail on Sunday can reveal that David Bowles, the former chairman of the trust which runs Grantham and Lincoln hospitals, warned senior NHS management that increasing the burden on services there would have disastrous consequences.
He said that when closing Newark’s A&E was first mooted in 2009, he had warned the now-disbanded East Midlands Strategic Health Authority (SHA), the body which pushed through the closure, that Lincoln Hospital was already ‘close to a tipping point’ because its patient load was so great.
‘There were no vacant beds at all, and yet the SHA was saying we had to admit more patients,’ he said. In such circumstances, it was likely that patients would be sent to the wrong ward, and the control of ‘superbug’ infections would suffer, along with patient care in general.
Mr Bowles’s concerns were ignored. Now, in the wake of the Mid-Staffordshire hospital scandal, both Lincoln and King’s Mill are among 14 hospitals being investigated over ‘excess’ patient deaths.
Meanwhile, a report commissioned by the Say Yes To Newark campaign from independent health think-tank Dr Foster has found ‘higher than expected mortality’ among emergency case patients from the NG23 and 24 postcodes treated at Lincoln from 2008 to 2011. Doctors in other areas facing A&E closures now fear similar consequences.
The trusts which run the hospitals where Newark patients are treated refused to comment yesterday.

Campaign: More than 30,000 Mail on Sunday readers have written to the Health Secretary to stop closures
They referred questions to Amanda Sullivan, chief officer of the Newark and Sherwood Clinical Commissioning Group – the GP-led body now responsible for buying hospital services in the area.
She claimed the increase in mortality was caused by Newark patients being ‘ill-er’ than they used to be because they have aged, while the criteria for admitting emergency patients to hospital had become stricter.

Those who might have been given beds in the past were now sent home, so that those who were admitted were ‘more likely to die’.

She admitted she had no hard data with which to back her assertions, but she insisted: ‘I don’t think the change [to Newark A&E] has worsened mortality.’
Last night a spokesman for Mr Hunt pointed out that the death rate increase began in 2010, the year before the A&E closed.



Delay: Muriel Powell had to travel 20 miles to Lincoln after Newark A&E closed, she later died
Muriel Powell, 85, was one of thousands of emergency patients affected by the closure of Newark’s A&E in 2011.
She had been in good health, but when she started to cough up blood, her family dialled 999.
A paramedic in a car was soon on the scene, but Mrs Powell had to endure a long wait for an ambulance to take her to Lincoln, more than 20 miles away.
Her daughter Pauline said she was eventually diagnosed with leukaemia. ‘They were constantly taking bloods, causing her great pain.

'No one lives for ever. But you do expect people at the end of their lives to be treated with dignity and compassion. That didn’t happen. My mother died in misery.’
In 2011 and 2012, Lincoln Hospital admitted
 1,800 Newark emergency cases a year.

A staggeringly high proportion – 8.15 per cent in 2011 and 7.82 per cent last year – were dead within 30 days.

This is more than double the average death rates at Newark when it had its own A&E.

GP chief: It's a sign of what may happen in YOUR area
By Doctor Clare Gerada, chairman of the Royal College of General Practioners


GP chief: Clare Gerada in chairman of the Royal College of General Practioners
We are facing a national crisis in emergency healthcare. The whole system  is under great strain – and this crisis  is not limited to hospitals. It also affects community and primary care.
Patients are waiting much longer to be seen in emergency departments. Trolley-waits, which had largely disappeared over the past decade, are returning.
GPs have seen consultation rates explode in recent months and now routinely see up to 60 patients a day – something which, in my 25 years’ experience as a GP in inner London, might usually occur in only exceptional circumstances, such as a flu epidemic.
In this context, The Mail On Sunday’s investigation into rising death rates among emergency patients from Newark, where the A&E department closed two years ago, is hugely important – and may well be only a portent of what will happen on a bigger scale when A&Es close elsewhere.
Without further analysis, it is impossible to conclude categorically that the increase in death rates is due to the A&E closure. But this would appear to be the most obvious and compelling explanation – especially when one factors in the impact of longer journeys to hospitals elsewhere.

Research led by Professor Jon Nicholl, at Sheffield University, has already shown that mortality increases with distance.

In his study, 5.8 per cent of patients who travelled less than 6.2 miles to A&E died before being discharged from hospital. Among patients who travelled more than 13 miles, almost nine per cent died – and it is around 20 miles from Newark to King’s Mill Hospital, near Mansfield, or Lincoln, where most Newark patients are now sent.
It is perhaps no coincidence that both King’s Mill and Lincoln are currently being investigated because of their overall excess deaths.

The former chairman of the Lincoln Trust warned in 2009 that A&E was under severe pressure and that closing Newark would only make matters worse.
Unfortunately, he was ignored. It is good that the Government has finally recognised that urgent and emergency care is not as accessible as it should be.
But in doing so, they are unfairly blaming GPs by claiming that a new contract, introduced almost a decade ago which allowed GPs to opt-out of providing out-of-hours care, has led to the current crisis.
This lazy accusation masks more obvious reasons why some A&Es can barely cope.
One far more likely explanation is A&E closures put more pressure on remaining A&E services.
The patients who would have used them won’t simply disappear.
It makes no sense to close yet more A&E departments – unless sufficient resources are provided to pick up the inevitable shift in workload when closures occur.

« Last Edit: December 21, 2013, 04:18:38 pm by roger »