How can NHS justify £200 million on new unit?

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Letter from Dr. Ray Monsell to the Echo on 13/11/20

Text:

How can NHS Trust justify £200m on new unit?

I WRITE in response to the letter from Professor Mead (“ambulance figures were misleading”, Echo letters November 9), challenging some aspects of previous correspondence questioning the safety of the service model for the New Velindre Cancer Centre.

This appears to be a partial and selective response. 

No-one disputes the need for a new build to allow the incredible work undertaken by the staff at Velindre to continue. 

The issue we have raised as clinicians concerns the proposed model for the New Velindre. The current hospital Is on a stand-alone site, unsupported by the many specialities required to care for actuely unwell patients.

At the New Velindre, there will be no surgery, interventional radiology, intensive care, on-site expertise for medicine, cardiology, neurology, gastroenterology, gynaecology. All of these require transfer to another site before specialist treatment can commence. 

To the casual reader, the figures for 2019 presented by Prof Mead appeared acceptable, with “only” 11 Red Calls, which are immediate life-threatening emergencies such as cardiac/respiratory arrest and choking.

She did not mention the 69 Amber One and Two calls in the 105 x 999 calls in 2019. (63 Amber One, six Amber Two). These are not routine transfers. These patients need urgent help not available at Velindre. 

The Amber One and Two categories include :

-Abdominal Pain;

-Allergic reactions (not alert, difficulty breathing);

-Breathing problems;

-Chest pains (abnormal breathing, changing colour, clammy, sweaty);

-Convulsion/fitting (continuous or multiple fits);

-Heart problems;

-Haemorrhage/laceration;

-Sick person (including not alert);

-Stroke; and

-Unconscious.

These were emergencies, in patients already sick due to the underlying illness that brought them to Velindre. 

The idea of using the 999 system for routine transfers might be viewed as an abuse of the emergency system, denying patients in the community these vital resources.

Eighty times in 2019, Velindre needed to escalate care to an acute hospital via the 999 ambulance; 80 Red and Amber One and Two. 

Similar figures were recorded for the preceding three years. The 25 Green calls using the 999 system may include patients transferred for treatment not available at Velindre.

The Trust has a duty to report any serious incidents to the Welsh Government. Prof Mead states: 

“Over the past five years no serious incidents have been reported to the Welsh Government due to preventable deaths onsite relating to a delay in transfer to an acute hospital.”

The Freedom of Information inquiry included details of an unexpected death. Out of respect for the family, this will not be discussed to avoid distress. 

The Trust stated in its FOI response: 

“The case was not reported as a serious incident as it did not meet the threshold for reporting”

Is an unexpected death not a serious incident? What is the threshold for reporting an unexpected death at Velindre.

The trust also stated: “The organisation does not hold one overall system that collates all patient interventions and transfers. We can confirm patients are transferred to other acute hospitals for a range of interventions and the details are accessible by clinical staff in the individual patient record.”

There is no central database that collates the information for patients requiring escalation of care from Velindre to other units in South-East Wales. If Velindre NHS Trust does not know what is happening in the present, how can it plan the future?

How can it justify spending more than £200m on a new unit when it does not know what it needs to provide? The patients and staff deserve better.

DR Ray Monsell

MSc MBBCh FFSEM Dip Sport

Med Dip IMC RCSEd

Cardiff

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