A&E closure: Hospital boss explains why he closed our A&E unit in this exclusive Q&A
After the closure of overnight services at Grantham Hospital’s A&E unit, reporter Nick Rennie sat in on a meeting between protester Charmaine Morgan and hospital boss Dr Suneil Kapadia.
It followed the closure on Wednesday of overnight A&E services at Grantham Hospital, which has sparked protests from angry residents.
United Lincolnshire Hospitals NHS Trust (ULHT) decided to close the unit from 6.30pm until 9am every day so staff can be redeployed at understaffed A&E departments at Lincoln County and Boston Pilgrim hospitals. The move is for an initial three months but there is no guarantee that the A&E unit will reopen at Grantham.
The Journal got together ULHT medical director Dr Kapadia and South Kesteven District Council member Coun Charmaine Morgan, who is also chairperson of SOS Grantham Hospital, which fights to save services.
This is how Dr Kapadia responded to Coun Morgan’s concerns about the issue:
**There are around 120,000 people in the Grantham area and that is a significant number who have not now got the same level of A&E services as people elsewhere in the county. Do you accept this?
SK (Dr Kapadia): If the A&E department was still open, we would still be saying don’t go to Grantham if you have a serious problem. You should be going to Lincoln or Boston hospitals depending on the severity of your problem.
Certainly, if I had a stroke or a heart attack outside Grantham Hospital I would want to be taken to Lincoln if it was a heart attack or Pilgrim if I had a stroke so I get the best possible care.
**What about mothers of young children or elderly people who have no means of transport? How can they get to these other hospitals?
SK: We’ve been in contact with East Midlands Ambulance Service (EMAS) and they’ve been fully supportive about what we are having to do. Our figures show that on average every day between 7pm and 7am there are 28 patients that self-present at Grantham A&E and six who arrive by ambulance.
Patients also have access to a GP out of hours service or they can be triaged via the NHS 111 system to get the treatment they need.
There is no perfect solution to this, no eutopia.
**There were about 300 people at the vigil on Saturday where we were protesting against the temporary closure and I spoke to many of them. The thing which is really concerning the community is that Grantham A&E has played a role in stabilising many patients before they get transferred on elsewhere. I’ve also spoken to three paramedic ambulance staff who have dealt with conditions ranging from choking to having serious asthma attacks and allergic reactions where time is of the essence. The paramedics told me that if they have heart patients, for example, who are in a serious condition in the Grantham Hospital area they will try resuscitation but if there is any chance they will drive to the A&E here because there is only so much they can do in an ambulance. They will now lose this fall-back. So there is this whole band of critically ill patients for whom these new hours will not cater for.
SK: If you have a heart attack on the east coast, even with an A&E department 24/7 at Boston Pilgrim, you should come straight to Lincoln Hospital, no matter how sick you are because data shows your survival rate is much better.
Cardiologists are advising that patients are not taken to Pilgrim to be stabilised. That just prolongs the delay.
Before Lincoln heart centre came into place (2013) the average mortality rate in Lincolnshire was around 10 per cent and on the east coast it was 13 per cent. The average mortality rate for heart patients is now 5.7 per cent and that’s better than the national average.
If I came off a motorbike and was knocked down outside Grantham A&E and was severely unwell I would want to be taken to NUH (Nottingham University Hospitals) as fast as you could take me because they specialise in dealing with these cases.
Ambulance staff are also highly trained now and able to initiate treatment and carry on with it as opposed to the old days of scoop and carry.
**I have spoken to staff here and they are arguing that what you’ve got here is an A&E department that does provide some critical care. Largely, the feedback from the public about the unit has been that it is excellent.
SK: We have to look at the bigger picture. Grantham Hospital has no intensive care consultants. It never has had any. That puts it into context about the type of patients that we should be accepting here. Nominally, we have six physicians who are on call overnight in A&E between them. We have five substantives, soon to drop down to four, but between them they provide specialist cover for four different specialities only. That’s it.
**Another issue is the time frame all of this has happened in one week. Why were we not given more notice?
SK: It’s one week on the grounds of safety. I don’t have the luxury of waiting a month, six weeks , three months when I’m faced at 7.30am with no medical staff on the shop floor in the busiest A&E department in Lincolnshire (Lincoln Hospital). That is unsafe. I can’t say ‘guys you’ve got hardly anyone there but we’ll wing it on a prayer’. That would be irresponsible of me.
**There would be a lot more sympathy for your position if during the last consultation we hadn’t already seen that Lincoln was struggling at maximum capacity and would struggle with extra patients coming in from Grantham. EMAS drivers tell me that they’ve been getting to Lincoln and they’ve been queuing for considerable amounts of time to transfer their patients over which has a knock-on effect on the availability of ambulances in Grantham. There is this blocking of the A&E unit at Lincoln aside from the issue of not enough doctors. Is that a true reflection?
SK: There are many factors which affect the flow through a hospital. That’s irrespective of what is hapening at Grantham overnight.
**I’ve spoken to staff at this hospital who are happy to move to Lincoln or Boston for a week or two but they are unhappy about doing it for any longer than that.
SK: No doctors are being moved. They are still based at Grantham. We’ve asked them if they are able to help out with shifts at Lincoln and they’ve stepped up to the plate. All A&E doctors based here will continue to do some work here because we recognise we have to make sure the A&E department in the daytime is fit for purpose and because we’re hoping to open up again in three months.
I am having to look at the wider picture as to where the bigger risks are. As I said earlier on, there is no easy solution to all of this.
Dr Kapadia also answered questions posed by SKDC ward councillor Ray Wootten:
**What guarantee can you give that a temporary closure means just that?
I would be insulting people’s intelligence to say I can give you an absolute guarantee. This has all been done on the grounds of patient safety and it’s for three months with a view to reviewing that.
**What have you done to recruit new doctors to fill the shortfall?
We’ve been on a recruitment drive to fill the doctors’ posts not only at Lincoln but also at Boston as well as Grantham. We’ve also been trying to recruit from abroad. We’ve been aiming to train nurses up so they can support medical staff.
**No hospital has a full complement of staff so why try to get one?
We’ve never said we would be trying to recruit a full complement of staff. What we’ve highlighted is we are falling short against national recommendations. Recommendations for three A&E departments would be 30 consultants. We would be delighted if we had 24. We have 15 so you can see how far behind we are.
**Are you trying to close Grantham A&E by the back door?
No. We’ve run on a shortage of doctors for some time. It was no longer sustainable to keep it going on a shift-by-shift basis. It got to the point where it was dangerous.
**What about patients who need urgent treatment and who may die?
Sick people are better managed at places that are better able to deal with them.