Concern about plan to cut hours of busy minor injuries unit

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A decision to reduce the number of hours at the minor injuries unit at South Tyrone Hospital could see an overspill of over a thousand patients a year to already under pressure A&E wards in the Southern Health Trust area.

Last September the Trust published a Strategic Review of Minor Injuries Units (MIU) and a number of options were put out for consultation. However, it has since emerged that the trust’s preferred choice is to reduce the hours at the unit at South Tyrone Hospital from 9am-9pm to 9am-7pm.

Local campaigners immediately voiced their opposition estimating that it would result in an extra 1,150 patients transferring to Craigavon Area Hospital (CAH) A&E per year – based on hospital figures for the 2010/11 year.

A final decision on the future of the Minor Injuries Unit will be made at the trust board meeting tomorrow (Thursday, March 29th).

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

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.

The South Tyrone Hospital Minor Injuries service in Dungannon is a nurse-led service and under the current system runs 9am-9pm seven days a week.

THE REVIEW

In the review document published last September, the trust listed several options for MIU’s future which were put out for consultation. However, subsequent meetings between the trust and hospital campaigners have revealed that it has become a choice between the service becoming 9am – 7pm seven days a week with back-up supplied by Armagh City Hospital, or 9am to 7pm, Monday to Friday, with increased cover in the Armagh unit. Under both options a loss of two hours per day would be mandatory for South Tyrone Hospital. Mullinure Minor Injuries Unit is also suggested for closure.

The South Tyrone Action Group, which fought against the eventual loss of acute services in South Tyrone Hospital over 10 years ago has continued to exist and has become part of a new group called the South Tyrone Community Forum. The forum has become increasingly frustrated with the health trust’s approach on the matter.

Local businessman and forum member Jim Kerr says he has struggled to understand the logic behind the trust’s decision to reduce the hours at the MIU.

He said: “This really came like a lightning bolt out of the blue for us. The success of this service has surpassed all our expectations with rapidly and continuously increasing numbers and excellent safety and quality records. In essence our hospital has been doing exactly what it is expected to do within its limits of being a non acute hospital, and probably more.

“Several meetings have taken place recently in Dungannon between the Forum, locally elected representatives, and the chief executive of the Southern Trust. At all of these meetings our total opposition was voiced as well as the facts and figures to justify our argument. However, I fear it’s falling on deaf ears.”

Southern trust figures

Southern trust figures

The Minor Injuries Unit originally started in 2001 with 8,000 new patients per year. Eventually patient numbers rose and that service was extended later to seven days from 9am to 5pm. Numbers increased annually to 12,000.

The service again increased its hours to 9am-9pm seven days a week with the hope that it would be able to handle 15,000 patients per year by 2007. The trust’s own figures show that last year the minor injuries unit saw over 18,500 patients with an expected increase this year to 20,000.

It is the largest and fastest growing standalone unit in Northern Ireland

OVER PERFORMING

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 Tyrones MIU had 20,598 attendances while Armagh had 9,680.

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.

Mr Kerr believes the key to the success of South Tyrone’s minor injury unit has been the fact that it has been able to take pressure off busy A&E units like Craigavon Area Hospital (CAH).

He said: “We appreciate the improvements that the trust has made at CAH’s A&E department and we wish to see those improvements maintained, but it’s all there in black and white. Closing the MIU from 7pm to 9pm each night would result in well over a thousand patients transferring to CAH A&E per year.

“When you think about how geographically spread out this part of the region is and without the back-up from an acute hospital, there is more of a necessity for longer opening hours in an efficient MIU like South Tyrone. It seems nonsensical to opt for a reduction.”

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

Mr Kerr said: “When this option was highlighted as the preferred choice, we asked the trust was there a quality issue? They once again reassured us that the quality of the service was first rate, with very low referral rates.

“We asked them then was it a financial issue – this is where everything became vague. They said that they as a trust had to ensure that they were giving a value for money service where it was most needed and that in the evening hours there was a fall off of patient use of the service.

“We asked them could they quantify how poor value for money this was. They could not give us any figures. Instead they came up with a figure of four patients per hour. For example if in the hours of 7pm to 9pm patient numbers per hour were below this magical figure of four, the service was not good value for money.”

South Tyrone MIU is fastest growing standalone unit in Northern Ireland

South Tyrone MIU is fastest growing standalone unit in Northern Ireland

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.

Mr Kerr believes that given the opportunity it would only be a matter of time before the MIU met the trust’s new targets.

“When you look at the trend of attendance over the past 10 years it’s consistently a positive one and I think the trust know that it wouldn’t be too long before it would average out to four patients per hour, but let’s not forget the trust are cherry picking particular hours here, which is completely unfair.”

The Souther Trust issued a short statement to The Detail. It said: “A decision will be taken at the trust board meeting on Thursday 29 March regarding the Strategic Review of Minor Injuries Units. It would be inappropriate for the trust to make any comment before that decision was made public.”

RUBBER STAMPED

With a decision due tomorrow the Community Forum fears from past experience that this will be a rubber stamping exercise and that a reduction of hours is inevitable.

Mr Kerr said: “We had hoped that fleshing out some of the issues as well as facts and figures would mean that logic would prevail but unfortunately that does not seem to be the case. Have the trust even considered what the transfer of another 1,000 patients to Craigavon’s A&E will mean for this already stretched service?

“There doesn’t really seem to a logical or strong reason for reducing these hours. Are there some other hidden agendas we don’t know about yet? Instead of being cut, I believe South Tyrone’s MIU should be looked in the context of the bigger picture.

“Surely the way our MIU unit works at present, supporting its local population and dovetailing with Craigavon Hospital to reduce volumes in A&E should be used as a model elsewhere, even in Belfast to take the pressure of the acute hospitals there? We strongly believe that not only is a good service being cut, but there is a missed opportunity here also and it’s something we are all still struggling to get our heads round.”

Speaking to The Detail ahead of the trust meeting, Sue Ramsey MLA, chairperson of the Assembly’s Health Committee, said: “Any decision that impacts on the possible increase in numbers of patients going into an A&E must be considered very carefully to ensure that quality of patient care will not suffer.

“It has become clear, over the past few weeks, that the service in A&E can be affected by procedures in other parts of the hospital, particularly those relating to admission and investigations. It is important that any plan which could result in higher numbers attending an A&E would take these concerns into account.”