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Nick Perry, the Lib Dem parliamentary campaigner for Hastings & Rye and father-to-be, has been chasing PCT Chief Executive Nick Yeo for answers to issues that concern him regarding the threat to maternity services. With Mr Perry’s kind permission we are reprinting his letters as sent and the replies received.
- Letter sent 28th August 2007, written by David Hancock -
Re: Death risk increased with longer ambulance journeys
With regard to proposals affecting the future of Women's Services and Special Baby Care in our area, you may be aware that Hastings & Rye Liberal Democrats have consistently supported Option 5, to preserve access to high quality maternity care in both towns. This is the option favoured by campaigners from the Hastings-based Hands off the Conquest organisation and the Eastbourne DGH.
When Hastings Borough Council voted for Option 4 on 9 July 2007, this was without Liberal Democrat support. Liberal Democrat members of Rother District Council also support Option 5 and opposed Option 4.
We are committed to doing all we can to make sure local people retain access to important, basic NHS services in their own area. We believe that weak infrastructure militates against cuts in Hastings or Eastbourne districts.
We therefore have grave concern over reports on newly published research into ambulance journey times and the findings that high risk patients are more likely to die after long ambulance journeys. The findings are from research carried out by the University of Sheffield and headed by Professor Jon Nicholl. They clearly demonstrate increased risk implications of greater ambulance journey times in emergency clinical situations.
Whilst acknowledging that the PCT will have to balance a number of important issues in coming to a final decision, we believe that this is further evidence in support of Option 5.
In the context of the decisions to be made about local maternity services later this year, we would be glad of your response in respect of Professor Nicholl's research.
- Reply received 19/10/07 -
Thank you for your letter seeking our response to the recently published paper The relationship between distance to hospital and patient mortality in emergencies: an observational study .
We have taken the concerns about risk associated with transfer in labour very seriously and have done a great deal of detailed work looking into research that could inform our risk assessment. However, we have not identified any research that addresses specifically the issue of transfers of mothers in labour to guide thinking on what might constitute a safe journey time. Likewise we have not identified any guidance relating to safe travel times or distances.
We were therefore very interested to see what this paper would add to the available knowledge and views that we have identified in this area. Having reviewed it and consulted our Regional Director of Public Health, we have concluded that the paper does not significantly change our current thinking because:
The group studied was very tightly controlled to include only patients who were unconscious, not breathing or with acute chest pain (but not cardiac arrests). This group seems unlikely to include many, if any, maternity patients.
The paper itself is very clear that results are not generalisable across different clinical groups and that ‘there is good evidence for some groups of emergency patients that care provided in specialist centres improves outcomes’. In this study the group where the relationship between distance and mortality was strongest was those with respiratory problems.
The view of the South East Coast Ambulance Trust is also relevant here. They have indicated that in their view ‘the study is clear in that increased risk to patients is relevant only to specific medical conditions related to acute respiratory problems’.
A number of methodological concerns have also been raised about this paper, though because the paper does not address issues relevant to our consultation these need not be rehearsed here - except to note that we agree with you that the key concern is time rather than distance, whereas this paper only considers ‘straight line distance’ not actual road miles or journey times.
One consequence of this lack of clear research based evidence is that there is a range of opinions amongst professionals, reflected by their national bodies as well as individual practitioners. However, looking at practice in other areas of the country has shown that stand alone midwife led units commonly operate at some distance from their consultant led unit (CLU). In a review of stand alone MLUs, all units identified as delivering more than 300 babies each year were situated between 9 and 24 miles from their nearest obstetric unit, though a few smaller units were at much greater distance from the CLU. We are reassured therefore that our proposals are in line with clinical practice nationally.
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