Cuts to injuries unit even deeper than feared

HOSPITAL campaigners have accused the Southern Health Trust of moving the goal posts after imposing a cut in weekend hours at Northern Ireland’s minor injury unit – which had never been discussed before.

During the latest Trust Board Meeting today (Thursday 29 March) at Craigavon Area Hospital, the trust revealed that the minor injuries unit at South Tyrone Hospital in Dungannon would stay open from 9am-9pm for a 12 month trial period, but it cut the hours during weekends from 9am-9pm to 10am-6pm.

In a story by The Detail earlier this week we revealed how the trust had indicated to campaigners that there would be a likely reduction in hours at South Tyrone Hospital’s Minor Injury Unit (MIU) from 9am-9pm to 9am-7pm across the entire week.

Local lobbying group the South Tyrone Community Forum were highly critical of these plans, estimating that it would result in an extra 1,150 patients transferring to Craigavon Area Hospital (CAH) A&E per year

But campaigners claim the new hours are even worse than they had feared – and they say they’re baffled that the plan now being imposed was never even raised as a possibility during consultations with them.

In a strategic review document published by the trust last September, the Trust listed several options for South Tyrone’s MIU’s future which were put out for consultation. The severe cut to weekend hours – passed at the latest board meeting – was not included in any of these models.

South Tyrone Community Forum member Jim Kerr said: “The trust has completely moved the goal posts here at the very last minute. The day before the crucial board meeting we are given a document with a brand new set of options laid out and, guess what, they’re worse than what was previously being offered.

“Everybody has come out of the meeting quite deflated. We were supposed to have had a consultation process but this morning was a rubber stamping process. The cut of the weekend hours was not part of the consultation. We plan to ask Dungannon District Council to look at the legality of these last minute changes. There is a clear equality issue here.”

Earlier this year subsequent meetings between the trust and hospital campaigners had revealed that the trust’s preferred choices involved a loss of two hours per day for South Tyrone Hospital. The decision taken today increases that to a loss of four hours at weekends.

There are currently eight MIUs throughout Northern Ireland, including one at Armagh Community Hospital whose MIU’s services also formed part of the Southern Trust’s review. During 2010/11 South Tyrone’s MIU had 20,598 attendances while Armagh had 9,680.

After today’s board meeting, Mullinure Minor Injuries Unit in Armagh has been earmarked for closure while Armagh Community Hospital’s MIU has received a stay of grace: it will stay open provisionally for a period of time between 9am-7pm. However if they don’t reach a target of four patients per hour, this will be reduced to a 9am-5pm service. It is losing weekend opening hours.

TRUST RESPONSE

Southern Trust Chief Executive, Mairead McAlinden said: “The changes proposed for the Minor Injuries Service reflect how the service was currently being used, and how it should be developed in future to provide a sustainable, high quality service which was provided to the same quality across the Trust.”

In its response to the consultation report, the trust acknowledged the total number of attendances in South Tyrone’s MIU has increased year-on-year and that it provides services to a number of rural areas. But it claims this increase in activity is occurring in core hours between 9am and 5pm with activity after 5pm on Saturday and Sunday reducing.

Mr Kerr believes this paints a wholly inaccurate picture.

He said: “The plain fact of the matter is that there is no single hour or segment of our MIU that has decreasing numbers. it just so happens that the numbers are increasing faster during 9am-5pm than they are in the evening, but there are no negative trends.”

The trust acknowledged that, based on attendances during 5pm and 9pm on Saturday and Sundays during 2010/11, this change in opening hours at the weekend could potentially impact upon 1,045 patients a year who would potentially have to attend an alternative service in the absence of a minor injury service.

PRESSURES ON A&E

In 2009/10 there were a total of 71,281 new and unplanned A&E attendances at Craigavon Hospital which averages 5,940 attendances per month. Over the last number of years new attendances at Craigavon’s A&E have continued to increase, with the Southern Trust claiming in its strategic review of MIU that CAH is “the busiest emergency department in Northern Ireland for the past five years”.

Campaigners predicted that a reduction in the number of hours at South Tyrone’s MIU would add more pressure to this situation and only serve to stifle a system that is currently overperforming in all its projected targets.

Mr Kerr said: “The trust have tried to discount the argument that all 1100 patients who will be suffering from the cuts will be going to Craigavon hospital and they quote a figure of only 50% of these figures will only be going to one hospital. The fact remains: for the people of this area there will only be on alternative and that is Craigavon’s A&E. We do not live in the greater Belfast area, so we do not have the luxury of choice. The trust know this.”

In the new document the trust say that the cost of the threatened hours per year is approximately £324,000, Mr Kerr believes this figure should not be taken out of context.

“What point is the trust to make with this number? Are we to presume that the one thousand plus patients who will have to travel to Craigavon will be treated for free? Will the consultants, registrars, nurses, radiographers there be giving their services for free along with machinery and materials used, where is this alternative costing for this?"

Speaking to The Detail, Ulster Unionist and Mid-Ulster Assembly Member, Sandra Overend, said: “I am concerned about the proposed reduction to the opening hours of the Minor Injury Unit at the South Tyrone Hospital, particularly in light of the problems which are currently plaguing A&E units across Northern Ireland.

“I am convinced that a reduction in the hours of the Minor Injury Unit would drastically increase the pressure on other A&E departments and hinder the current quality of service provided.

“I am keen to ensure that the hours of service for the Minor Injury Unit in South Tyrone Hospital are secured and, where possible, extended. And I have taken efforts to ensure that the Health Minister and the Chief Executive of both the Northern and Southern Trusts take these views into consideration.”

In recent weeks the Royal Victoria Hospital has been making headlines because of ongoing problems at its A&E department, problems that have been escalating since the closure of the A&E department at the City Hospital in Belfast last year.

In Mid Ulster the recent closure of Magherafelt Hospital’s A&E last year has led to more patients attending South Tyrone’s MIU. Campaigners say a reduction in hours at South Tyrone’s MIU would cause a domino effect leading to a dramatic increase in the number of patients travelling to Craigavon Hospital.

In 2010/11 South Tyrone had 22% of all attendances of all MIUs in Northern Ireland with the latest figures showing the first three months of this year to have been its busiest yet. Internal figures obtained by The Detail show that from January to March 2012 the MIU had 4,216 patients, up from 3,800 patients at the same time last year.

The Southern Trust previously told the forum that in order to justify continuation of the hours between 9pm to 7pm the MIU needed to be averaging four patients per hour.

The trust’s own figures for 2010/11 show that the current average of patients attending the MIU in South Tyrone averages at 4.7 per hour, although this is for the full 9am-9pm shift.

However internal figures received by The Detail outlining patient numbers for the first week of every month this year show that the average breakdown of patients for the hours between 5pm and 9pm at South Tyrone’s MIU works out at three patients per hour.

In recent months the Tyrone Community Forum have asked the trust for an explanation on the four patients per hour number, it was confirmed to them that it was not a national guideline.

Mr Kerr believes that the gradual increase in these figures have fed directly into the trust’s latest decision to change the proposed cuts once again.

He said: “it would have been only a matter of time before the MIU met the trust’s new targets so we believe this is a very cynical move. The increase in numbers have brought them closer to the magic number of four patients per hour threshold. South Tyrone seems to have become too successful for its own good and the trust see this as the opportune time to implement these cuts.”

“If you were a patient who either wasn’t sure that your MIU wasn’t open at present or perhaps thought it was too near closing time to go there, maybe in our case at 8:45pm in the evening, you probably regretfully would move on to wherever was open. In our case this would be Craigavon. There will always be a tendency for numbers to fall off in the last hour of a finite service for reasons like this and the trust are aware of this."

Speaking after the meeting, former Health Chair and local MLA Michelle Gildernew said: “Primarily the feeling is one of disappointment. While I welcome the fact that the current weekday services will be maintained, this is still going to be reviewed with a potential of reduction. The most disappointing element is the reduction in the weekend hour. I feel that this will add to the confusion and damage the numbers that are currently coming to the MIU.

“One of the reasons the Southern Trust haven’t been plagued with the kind of problems we’ve seen in other A&Es whereby people are presenting at an emergency department which would be more appropriate at an MIU is because South Tyrone’s department has been there to manage this.

“The direction from the minister and the Compton Report is that people should go where they can get the most appropriate level of care. For people in the surrounding area of South Tyrone, that place is its MIU, regardless of the hour.”