Gorse Hill Labour

A regular blog and updates from Mike Cordingley, Councillor for Gorse Hill Ward in Trafford – Gtr Manchester.

Response from Cllr Mike Cordingley to New Health Deal for Trafford Consultation

Below is my response to the consultation.
Closing date is 31st October 5pm.
You can complete the consultation online.
I urge you to do so.
It’s vital that the views of residents in Gorse Hill Ward are taken into account.

 

Do you support our long-term vision for an Integrated care system in Trafford?

I support it with some reservations

The integrated care model is the only way forward in improving health outcomes. The recent research showing that a quarter of instances of bowel cancer are only diagnosed after admission to A&E highlights that accessibility to health provision is not where it should be. We do not have easy convenient access. Many people are only seeing a health professional as a last resort.

Once in the hospital machinery we know that patients (particularly the frail) are staying in hospital for too long without clinical need for them to be there. The only alternatives offered are discharge to the expensive care industry or inadequate support at home.

I am concerned too that there seems to have been very little research into the assimilation of mental health care into the integrated care pathway. What little I could find on the web suggests positive outcomes but also suggests the need for more thinking in this area.

For example see the evidence review made by York University for Leeds NHS trust which concludes that the evidence base is insufficient.

We know that early intervention works. We know that the quality of care provided by GPs for patients with mental health problems is inconsistent and can be a contributory factor in variations of likelihood for presentation at A&E.

I very much support the integrated care model but would want to see greater consideration to mental health aspects than is contained within the consultation. I am also disappointed that progress towards an integrated care model is framed in the consultation as an alternative to local provision of A&E. There are many positives in respect of integrated care but it should not be seen as an ‘either or’ with A&E.

I can not ignore my own suspicion and widely held by my constituents that there will be insufficient funding to provide an effective provision of integrated care. I see little evidence within the consultation paper suggesting that the remodelling will do other than reduce the financial deficit;  rather than free up funds to enhance improved community provision. There is an argument that in reality a quality integrated care model will be so financially demanding that the benefits in tackling health inequalities will never be realised.

I fully support the vision but I’m gravely sceptical about the delivery. The amount of investment needed in Gorse Hill, Firswood and Old Trafford to deliver even a basic level of care under the current model is huge. The standards expected for the integrated care model raise the financial demand to unreachable levels without a contribution from National bodies.

Do you accept the view that Trafford hospitals need to change in order to make sure services are high quality, efficient and affordable?

I have serious reservations about this view

The Guardian reported on 24th October 2012 that only a small number of trusts were breaking even on their Accident and emergency departments. This suggests to me that the funding regime for accident and emergency treatment is out of kilter. We obviously can not close every accident and emergency dept that is in deficit. I do not therefore accept the financial case.

The safety and quality issues are weightier, but here again there are reservations. Anecdotal evidence has challenged the figures used for attendances at the hospital’s A&E. It is clear to me that there is sufficient scepticism within the community over the figures for overnight admissions that the case is not yet made. We do need authoritative figures.

And the quality/safety argument has to include consideration of accessibility/travel-times to alternative provisions. We know that the ambulance service is already stretched. We know that links to Partington, Carrington and Woodsend by public transport to other centres are poor and will need to improve.

By definition any changes in provision at Trafford General will have an impact on other centres. I am extremely disappointed in the extent to which these other centres have engaged in the consultation. For residents in Gorse Hill Ward, Trafford General is their primary Accident and Emergency Unit. It is the nearest unit for most but not all residents within the ward; as some will be nearer to either Salford Royal or MRI. We have heard very little about the effect on capacity at these two hospitals. Certainly it seems anecdotally, that Salford does not want additional Trafford Patients. The commissioners have focused on Wythenshawe given its relationship to the South of Trafford, but for many in the North of the borough, Wythenshawe is only the fourth closest hospital. It is hard to avoid the conclusion that, should Trafford surrender some of its provision, the finances released will not be put to safe quality care accessible to patients displaced from Trafford General.

The overall impression is that Trafford residents are being thrown to the wind. The plan lacks a cohesive steer and that is neither reassuring on quality nor safety. Perhaps the cohesion in the plan will come from the forthcoming ‘Healthier Together’ review across Greater Manchester but that makes the argument compelling for this proposal to be only considered as part of the wider review. How can we be assured that quality will improve, when it is not certain how provision will be allocated across the city region?

 To what extent do you support the Orthopaedic Centre in our proposal ?

I support it with some reservations

The proposals are welcome. Suggestions for utilisation of the facilities at the former Greater Manchester Surgical Centre are particularly encouraging, and steps must be taken to ensure they’re fully realised. However we learned from the surgical centre that a contributing factor is the inaccessibility of Trafford General for the rest of the conurbation and whether we like it or not, there will be resistance from patients in other parts of the city.

We will want to ensure that Trafford General raises its reputation beyond those in the locality.

 To what extent do you support the outpatients element of our proposal?

I support it with some reservations

I believe this is a positive aspect and would expect improved out patient treatment with greater outreach care undertaken. The integrated care model should include this aspect within the design. Consultants should not be an add-on but integrated into the model.

The effective delivery of good or excellent outpatient care in a community setting is constrained by the shamefully poor quality of health infrastructure in many parts of the borough, particularly Gorse Hill and Old Trafford. The Gorse Hill Surgery together with Seymour Grove, Stretford Memorial and many other locations are not appropriate settings for 21st Century health provision.

 To what extent do you support the discontinuation of intensive care and emergency surgery in our proposal?

I do not support it

I have more difficulty with this question than any other aspect within the consultation. I have to be mindful that the low numbers does place a question mark over the quality and safety of provision. It is a compelling argument.

Nevertheless, the ‘Healthier Together’ review next year has to look at provisions across Greater Manchester and in my view we should look at what Trafford General’s role is within the revised specification before withdrawing services.

 To what extent do you support the downgrading of Accident and Emergency provision in our proposal?

I do not support it

Again the decision should be deferred until the ‘Healthier Together’ review is undertaken.

However additionally, we have not been given any assurance from the ambulance service given the extra mileage and possible additional waiting times. Nor do we have assurance that other centres can cope. There is a case to be made for investment in Wythenshawe as it is already over capacity. Reducing A&E provision will mean more patients admitted to other hospitals and there is no good public transport provision to any of them for visitors or aftercare.

 If our proposal is taken forward, are there any issues relating to emergency care (intensive care, emergency surgery and accident and emergency) that we need to consider?

Public Transport and better signposting both literally and figuratively. We know that severe trauma cases will already be ambulanced away from TGH. How is the parent driving a sickly child to know the quickest route to the most appropriate hospital?

How do we provide a quality response to Partington?

 Are there any aspects you feel have not been considered?

I simply want to highlight the urgent need for better quality facilities in Gorse Hill, Firswood and Old Trafford.

I feel that A&E has dominated the debate, but there are other issues including additional pressure on the GP’s out of hours service that have struggled to get a hearing.