BOURNEMOUTH AND POOLE (ACCIDENT CENTRE) (Hansard, 12 October 1976)

§ Mr. John Cordle (Bournemouth, East)

It is particularly apposite that I have to raise a matter in respect of the health services in my own division, the subject of casualty ward facilities at the Boscombe General Hospital. I am grateful for the opportunity of bringing to the attention of the House a matter which is causing very considerable concern and anxiety to my constituents. That is the centralisation of accident services at the Poole General Hospital.

393 The position until recently was that the Bournemouth-Poole area had two hospitals with accident facilities, one at Boscombe—the Royal Victoria Hospital—and the other at Poole: in other words, one at the eastern side of this urban area and the other at the western side. The arrangement was obviously sensible because ambulances with emergency cases never had a particularly long journey to reach the nearest hospital. The arrangement was satisfactory to the people of Bournemouth.

Unfortunately, recently that satisfactory state of affairs has ceased to exist. There has been a so-called centralisation of accident services on Poole and a withdrawal of those services from the Royal Victoria Hospital. Two factors have, apparently, contributed to this. They are difficulties in staffing and regional policies which favour the permanent centralisation of accident services with only one accident centre for Poole and Bournemouth, situated for the present at Poole and, upon completion of phase 2 of the Castle Lane Hospital, later at the new Castle Lane Hospital.

The decision to withdraw accident services from the Royal Victoria Hospital has caused a great deal of dissatisfaction in the area previously served by that hospital's accident department. I used the word "dissatisfaction", but perhaps I was putting the matter too mildly and it would have been more accurate to say that the decision has caused anger and anxiety, because it is seen to be a decision that places lives in jeopardy.

When dealing with accidents of all sorts it is not merely minutes that always matter but seconds that can be vital in many cases. Now, the man who suffers from a heart attack in Boscombe must face a journey right across Bournemouth to Poole, right through the centre of the town, and one is speaking of journeys of perhaps 20 minutes in the middle of winter, when traffic is comparatively light, and up to 40 to 50 minutes in the height of the busy summer season when the town is packed with holidaymakers.

According to the area health authority the number of persons seen by the accident and emergency department at Poole in 1976 who would have been treated at the Royal Victoria Hospital's department had that been open were: in January, 394 899; February, 942; March, 874; April, 1,172; May, 1,255; June, 1,310 and July, 1,496, giving a total number of 7,948. I do not have the figures for August and September but if one assumes that they were no higher than those for July, that would make a grand total of almost 11,000 people this year who have been forced to trek across the town for their accident and emergency treatment.

In my view, and I know that it is also the view of most of the medical staff in the district, and also of the vast majority of my constituents, there should be two accident centres in the Bournemouth and Poole area and that in the immediate future the accident department at the Royal Victoria Hospital should be reopened at the earliest possible moment. Let me therefore comment upon and deal with each of the two factors which have contributed to the decision to close that accident department. I shall deal first with the "policy" ground.

If it is indeed the policy of the area health authority to provide only one accident centre for the Bournemouth and Poole area, it is a thoroughly bad policy which should be and must be reversed. I do not doubt for a moment that there may be areas where a population of comparable size to that of Bournemouth and Poole could be properly and adequately served by one accident department. But the population of Bournemouth and Poole is spread over a very long front and the distance from west to east is accordingly too great for an urgent care case to be forced to make the journey.

In other words, the policy of only one accident centre is totally incompatible with the geography of the area. None of us here can alter the geography and, accordingly, the policy must be changed to produce something sensible and realistic for the area that actually exists. When the policy has been changed, one must then face the manpower problem.

The other factor influencing the decision to withdraw the accident service was the difficulty in staffing the Royal Victoria Hospital. In the long term, this difficulty can only be overcome by ensuring that all our doctors and nurses are properly remunerated for their arduous, exacting and responsible work and remunerated so that large numbers of them no longer feel the urge to emigrate in search of the 395 higher standard of living for themselves and their families that they feel they have earned.

However, in the short term let me suggest that there is a solution possible in the Bournemouth area. There are many retired doctors and nurses living in in Bournemouth and many, I am sure, would be prepared to offer their services on a part-time basis in order to enable the accident department at the Royal Victoria Hospital to be kept open. These persons would, I am confident, respond to any call for assistance in order that they might be able to assist their fellows in the area by sacrificing a day or two of their retirement each week. That solution might not seem the ideal one, but it is a far better solution than that presently adopted and called "centralisation".

Centralisation might be administratively neat and convenient but, unfortunately for administrators, the population of Bournemouth was not centralised and remains sprawled along the coastline. While the people are spread, so must the doctors be spread among them if they are to be able to perform their basic functions of saving life and alleviating suffering.

The total absurdity of the present situation can be seen only too clearly in an example which was given to me by Mr. Sparrowe, one of the doorkeepers in this House, when he heard that I was to raise this subject. I cannot do better than quote from his letter of 4th August this year: On 5th June 1976 my mother, who was 66 years of age, was taken into Boscombe Hospital with heart trouble and was in the intensive care unit for two or three days. During the morning of the 18th, she was left alone in a bath which eventually got cold. As the bell failed to attract the attention of the staff, she decided to leave the bath on her own. During the attempt she slipped and hurt her back and arm. This was about 11.15 a.m. Eventually she was found by a member of the staff and she complained about pains in her arm and back. After X-rays were taken at Boscombe Hospital, it was found that her arm was broken. My sister was informed of the accident at 3.45 p.m. and told that my mother would be taken to Poole Hospital for the arm to be set. She arrived at Poole at about 6 p.m. where her arm was duly set. She finally arrived back in her ward at Boscombe at 10.20 p.m. During the whole of the day and for several days afterwards, my mother was in a shocked state, and since the accident never fully recovered. My mother passed away on 27th July. 396 That is not merely a tragic incident but illustrates the absurdity of the present situation. An accident at the hospital in Boscombe has to involve a journey to Poole for accident treatment. How can such a sequence of events be prevented? Surely the answer is simple and obvious—reopen the accident department at the Royal Victoria Hospital at once.

§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)

I am grateful to the hon. Member for Bournemouth, East (Mr. Cordle) for raising this matter. I am of course aware that some local people have expressed concern about the centralisation of accident and emergency services for the East Dorset Health District at Poole General Hospital, and the consequent reduction in the service provided at the Royal Victoria Hospital, Boscombe. Such concern is not unusual when a reorganisation of this kind takes place. I hope that what I say will help alleviate the anger and anxiety of his constituents which the hon. Member mentioned.

I can assure the hon. Member that the centralisation of facilities was designed to improve the accident service in the district. This particular development, which was brought fully into effect in January this year, was one of a series undertaken by the Dorset Area Health Authority with the aim of providing the best possible level of patient care in East Dorset within existing resources. There were full local consultations on the proposed developments in 1973 and, following its establishment in 1974, the East Dorset Community Health Council was consulted and gave its support. The council has since reconsidered the matter and confirmed its support.

The centralisation of accident and emergency services at Poole is in line with my Department's policy on accident and emergency services. This is derived from the report published in 1962 of a sub-committee of the Standing Medical Advisory Committee—the Platt Report. The basis of the Platt recommendations is that it is necessary in the patient's interest to concentrate accident and emergency services into major departments. The object is to ensure that there are available all the medical and nursing skills, the supporting services, and the equipment needed for expert diagnosis 397 and immediate life-saving treatment for injured patients and other emergency cases. A range of medical disciplines may be involved. It is not possible for every hospital to be staffed and equipped to the necessary high standard to deal with emergency cases, and concentration is therefore in the best interest of the patient with a serious injury or other emergency condition.

It is better for such a patient to be taken direct to a major department, even though this may involve a longer ambulance journey than to be taken to a nearer hospital which does not have the necessary skills available, and then have to be transferred to a hospital with a major department. I take on board that this is a coastal conurbation. The distance involved is about five miles. The Department commended the recommendations of the Platt Report to health authorities as a basis for planning the development of accident and emergency services, by way of a departmental memorandum in 1963. Further guidance, which supplemented the original advice, was issued in 1968.

In taking their decision to follow this guidance to centralise accident and emergency facilities for the benefit of patients in East Dorset, the health authorities were also mindful of increasing difficulty in recruiting and retaining the junior medical staff necessary to man the then existing departments at the Poole General and Royal Victoria Hospitals. Junior doctors have become increasingly selective about the specialty they adopt, particularly in terms of job satisfaction, training opportunities and career prospects. In the past the clinical supervision of the accident departments at the Poole General and Royal Victoria Hospitals was the responsibility of one orthopaedic surgeon who was engaged full-time in his specialty, and was therefore able to devote very little time to clinical supervision or teaching. In addition the junior doctors were obliged to spend a disproportionate amount of time treating trivial injuries which could be treated perfectly adequately by a general practitioner and which did little to improve their training and experience in dealing with serious injuries. This sort of pattern was typical of the traditional hospital accident department.

398 The centralisation of major accident and emergency services into a new improved department at Poole, and the treatment of minor accidents by general practitioner assistants at the Royal Victoria, has resulted in a vast improvement in the staffing. The appointment to the Department at Poole of a consultant specialising in accident and traumatic surgery was one of the first authorised in the country by my Department with the aim of providing a career structure and attracting more young doctors to this important specialty. The consultant at Poole is supported by a medical assistant, a registrar and a number of senior house officers.

The original accident department at Poole has been extended and improved and a new dental department has been added, together with an additional X-ray examination room. The minor accident unit remaining at the Royal Victoria Hospital is open from 9 a.m. to 4 p.m. every weekday. It is the area health authority's experience that most accidents in local industries, schools and on the beach occur between these hours. It may not be generally appreciated locally that at the Royal Victoria Hospital there will be, as there always has been, a reception area open 24 hours a day, seven days a week, for the admission of acute medical and surgical emergencies, with doctors from the medical, surgical and anaesthetic departments continuously and immediately available. This hospital has its own intensive care unit and coronary care unit for just such emergencies.

The reception area and emergency team will also be available for the emergency treatment of patients who are so severely ill that the doctor concerned or the ambulance crew involved consider that the journey to Poole General Hospital would endanger the patient's condition. I take on board the point about free access where that facility will be absolutely crucial and I understand the anxiety of the hon. Member's constituents. Such instances are extremely rare, but they occur in cases of drowning or severe blood loss. The telecommunications link between the central ambulance control and the hospital allows for early warning of the impending arrival of emergencies of this kind.

399 I have taken note of the hon. Gentleman's suggestion about the use of medical personnel, and I am sure that the area health authority will take it into account in any further consideration it gives to the problem. I hope that what I have said will enable the hon. Gentleman to reassure his constituents, whose anxieties 400 I understand, that the arrangements now in being will enable the health district to provide a better service for anyone who is unlucky enough to sustain a serious injury.