Ann Farrar Letter pasted on Facebook WCH page. Difficult and long posting to read, You say ‘My priority will always be ensuring patients can access to safe services as local as possible’ --That is in fact not happening, yes services are safe and local for patient living near CIC, however it is not safe and local for the patient who are living further away. Waiting for transport, non availability of bed at CIC, some wait to get a bed in CIC, some more wait to start treatment, operation cancelled at last minute. All these are very routine experiences for patient from west Cumbria. ’You say ‘For too long the West Cumberland Hospital and Cumberland Infirmary have been under performing. More people were dying which resulted in high mortality rates for both hospitals. --How long would you say it was under performing? As I recollect,that until 2011 CIC and more importantly WCH was working according to national standard. It appears that after change in health care provision, Retention of existing staff, and recruitment difficulty started. --New management came in with changes in policy for both hospitals CIC and WCH without consultation with local senior clinical staffs of these two hospitals, and health care provision changed without consultation with public. You say ‘The Care Quality Commission decide, whether hospital trust is safe, well led, caring, responsive, and effective --And following what actually has been said by CQC. Medical and nurse staffing • There were numerous consultant vacancies that were adversely affecting timely treatment for patients and effective Why there are numerous consultant vacancies? Support for junior doctors in a number of core services. • Nurse staffing levels, although improved, remained of concern and there was a heavy reliance on staff covering extra Why nursing staffing level is still a concerned? Shifts, and bank and agency staff to maintain adequate staffing levels. Adequate staffing levels were not consistently achieved in all core services. Why is it that adequate staffing level still has not been achieved? Service changes • There had been changes to the functions within both accident and emergency and surgical services regarding the management of trauma, high risk general surgery and colon rectal cancer patients, which began in June 2013. This care has now transferred to the Cumberland Infirmary in Carlisle. This has led to routine elective work being regularly cancelled at the Cumberland Infirmary, --Why routine elective work is being cancelled at CIC? But the transfer of routine work to West Cumberland has not been as Systematic as anticipated, as patients prefer to wait to have their procedure at Carlisle. --Why transfer of routine work to WCH has not been systematic? Why patients prefer to wait to have their treatment at Carlisle? CQC seems to know the answer. The distance between the two sites appears to be a major factor in patients’ decisions regarding where to have their surgery rather than the care delivered. --Even CQC has noted that distance between two hospitals to be major factors in patient’s decisions regarding where to have their surgery rather than care delivered. --Why is it patient from Carlisle has that choice of where their care is delivered, while patient from west Cumbria has no choice at all where their health care has been delivered, is safe, accessible and locally provided health care? If CQC is of opinion that distance between two hospitals has been a major factors, that why is it, your managers has difficulty grasping these fact. • This had exacerbated the trust’s inability to meet referral to treatment time (RTT) targets for admitted patients, particularly in orthopedics. The distance between the two sites was a major factor in patients’ decision making. CQC has also noted that in Orthopedic, distance between two site was a major factor in patient decision making, why than same choice not been offered to patient from west Cumbria, where would they like to be treated? Staff concerns and whistle blowing We were concerned about the lack of openness of the culture within the trust as we received a high number of anonymous whistle blowing concerns about this hospital before, during and after the inspection. This indicated that staff felt unable to share concerns with the trust despite the concerns being about patient safety and the quality of services provided. --View of CQC is that, staffs are afraid to speak out. Is there any surprise, that you have difficulty in recruiting? Unless you and your management become open, and honest with staffs and public you will continue to face difficulty in retention and recruitment. Hospital managers may move away to greener pasture but people of west Cumbria will end up with suffering, for their health care for generation to come. Shortages of both nursing and medical staff, together with pressures on bed availability, meant that care and treatment was not always being provided in a timely way. --All above comments are made by CQC clearly indicate that in their views important changes need to be made, and they are -- -to improve medical staffing level, -to improve nursing staffing level -to allow free expression of concern staffs have about clinical care, without fear of victimization -There should not be any climate fear in working environment for staff --Hospital managers do not appear to have followed any of the above recommendation. However hospital managers have concluded that only way to provide safe services is to transfer all emergency care to CIC, and this presumption quite evidently a selective action on part of a Hospital Managers, without paying any attention to other recommendation by CQC. --No where in CQC report, it says that emergency services need to be transferred to CIC to improve outcome of the treatment. You say, ‘Our mortality ratio is now within the expected range for the first time in many years.’ --You seem to suggest that mortality ratio was bad for years, Do you think that poor staffing level, as noted by CQC has any thing to do with it? --Or in hospital managers’ opinion, adequate staffing level is of no consequence, as no where in hospital manager’s press release -and there were many-which talked about mortality rate, but there is no mention of medical and nursing staffing level, as if there is no connection between mortality rate and staffing level. You say, ‘The transfer of high risk patients to the Cumberland Infirmary has meant more patients are traveling further for urgent treatment. However we know that this change is saving lives, something I am confident you will support’ --Is broken wrist, broken ankles, broken forearm bones, dislocated joint a high risk surgery? Is infected and inflamed joint high risk surgery? is appendicitis is high risk surgery? Is treatment of this simple injury, and illness are life saving procedure? Why are they being transferred to CIC? You say, ‘The peak of transfers over the summer period was around two patients per day and we are working with the teams to reduce the amount of transfers which take place, as clinically appropriate.’ --Could you share the breakdown of statistic of two patients a day, what were the diagnosis, condition of the patient at the time of transfer, were they surgical patients, Trauma patients, or any other category of the patient. Were patient transferred from WCH A&E to CIC A&E, or was it WCH ward to CIC ward? Are patients themselves travel to CIC from outpatient, or Fracture clinic included in this statistics? You say, ‘This change, some of which is made as a result of temporary safety grounds. Still requires consultation, and we anticipate this will happen sometime in 2015’ --When in 2015 this consultation will happen. Is it before or after WCH become elective operation center? --Are these changes made on safety grounds are interim, temporary or permanent? As you have responded to a question by saying, ‘Services which has gone are not coming back to WCH. --So if that is your view, and your mind is made up than, what is the point of consultation? You say, ‘in table attached, Emergency surgical admission in WCH, in 2011-12 -- 2284, 2012-13--2149, 2013-14—1685, --How many of these surgical emergency admissions, after 5 pm, in each year, included in table and how many of those admitted had their operation carried out in WCH after 5 pm.? --How many of those emergency admissions were transferred to CIC, if any, for further treatment to CIC, after being admitted to WCH? You say, ‘in table emergency surgical procedure in WCH 2011-12—2090, 2012-13—2001, 2013-14—1218, --How many procedures in these numbers includes, patient transfer from WCH A&E to CIC A&E, or WCH ward to CIC ward, or patient travelling themselves from Outpatients and Fracture clinic from home to CIC, for further treatment for condition which is high risk surgery? --And how many of these emergency surgical procedures, were high risk procedures in each year included in table on a patient transfer from WCH? You say, ‘future of west Cumberland Hospital is secured, with patient from the local community being able to access a wide range of services.’ --Does future of west Cumberland hospital include emergency and consultant led maternity health care? --Does wide range of services at WCH includes emergency general surgery and Trauma surgery ( Broken bones and dislocated joint)?
Posted on: Fri, 17 Oct 2014 15:27:20 +0000
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