Campaigners outline their fight for essential services
On 25th May Lincolnshire Clinical Commissioning Group supported proposals to permanently downgrade Grantham A&E to an Urgent Treatment Centre. This is both unsurprising yet shocking.
The changes planned by the CCG will transform our once excellent District Hospital into little more than a cottage hospital with minimal Acute Care and a focus mainly on elective surgery. This is despite our town’s increasing population and further development plans which could attract millions of people each year to our area should they go ahead.
In addition to downgrading our A&E, the CCG also approved removing emergency fracture treatment at Grantham. Those with fractures will now have to travel, in pain, to an alternative A&E. Also, in proposals to move all emergency stroke treatment for the County to an overstretched Lincoln County Hospital, Grantham patients were not even considered, although Boston residents were.
A risky running down of services
Crucially the CCG decision cements a failure to fully restore over 70 Acute Care beds lost after the illegal closure of Grantham and District Hospital in June 2020 in response to Covid 19. The Acute Care beds play a vital role in the longer-term treatment of critically ill patients who have come through A&E. They also provided excellent training opportunities for specialist consultants whilst giving holistic care to patients with complex medical conditions. Without spare capacity the Acute Care beds at Grantham Hospital will no longer be able to support Boston and Lincoln Hospitals in the event of a ‘critical incident’ or winter pressures. The loss of beds will put more focus on Care in the Community at a time when we know GP s and pharmacies are already under huge pressure. It will be vital that full needs assessments are completed and care plans are in place for all patients before release, including those who are treated in A&E and released without being admitted into hospital.
A key concession made to campaigners to restore services 24/7 in the Urgent Treatment Centre will provide help for the majority of those who are less seriously ill. We are told that resuscitation skills will remain on site but other lifesaving emergency treatment will not be available. The unit will have consultant support but it is not clear if they will be on site nor how long it will last if more acutely ill patients make their way elsewhere and the CCG consider this no longer viable (as they did after changes to our former Maternity Unit). There is a risk emergency patients may go to Grantham Hospital only to be subsequently referred to Lincoln or Boston where they face further delays before receiving appropriate treatment.
Out of area care presents challenges
The increase in planned elective surgery at Grantham is welcome but it will support the entire county and the complexity of cases to be handled will depend on the medical skills and support available. We have been advised the existing theatres are being used at approximately a quarter of their capacity so there was already scope for improvement before the new theatres were built. There is also a question of how patients will be prioritised for care given people will be travelling cross county to use the facility and the NHS is targeted to treat more private patients.
It is clear under the CCG plans the most critically ill patients will have to travel cross county. It is also clear more local people, especially elderly, will need to be placed in beds far from their family and friends within and outside our county at Nottingham or Peterborough.
There has been no re-consideration of the plans in view of the ‘cost of living crisis’ which will make it even harder for those on low incomes to afford the fuel and parking charges if they have a car. Those without a car face increased fare. Lower income staff transferred to Lincoln or Boston will have the same issue daily. The plans will put more pressure on an already stretched ambulance service. Both emergency and non-emergency.
Local people have been ignored
The CCG report did not fully reflect the number of people objecting to the changes in the Healthy Conversation informal consultation in 2019 nor the number who most recently signed the SOSGH petition in response to the latest plans. There is a general reference to having received a petition.
One of the most concerning aspects of the decision is that it was made despite the report acknowledging, whilst there may be some benefits to the proposals, those who have Protected Characteristics will be affected the worst. That includes disabled people, households on low incomes, the elderly and children. Those with the highest level of concern are disabled people living near Grantham Hospital.
We have been campaigning to save our local A&E for over 15 years. The first attempt to downgrade it came when the Primary Care Trust consulted about the future A&E and Maternity unit. We submitted a petition to Downing Street of over 25,000 signatures. The PCT consisted of both NHS staff and local councillors. They listened to us. Both units were saved. However, since the loss of PCTs and replacement of these bodies with CCGs, there is no longer any meaningful public representation at the decision-making table.
The Lincolnshire County Council Health Scrutiny Committee has to be consulted but even their limited power to refer cases to the Secretary of State, which we achieved in 2016 when the A&E was ‘temporarily’ closed at night has been watered down in recent Government plans for the NHS. Our 80,000-signature petition and protest with over 6,000 people and calls from Wednesday vigil attendees have fallen on deaf ears. The same fate has applied to our 30,000 signatures in 2019 and the 1,100 responses sent to the CCG during the Acute Service Review 2021. But we are right to protest and petition. In the 2021 Judicial Review the judge referred to the level of concern from our community in response to actions by ULHT. He also said that for consultation to be meaningful the comments we make should be reflected in the outcome of any plans.
Plans for the future
In the last decade over 30 A&E units nationally have closed or been downgraded. Our A&E network is at the heart of our NHS. Those in Westminster who state they care about our NHS must put a stop to this. Instead, MPs, including our own, voted to support plans that further weaken our say and increase the involvement of private organisations in our NHS.
In the meantime, SOS Grantham Hospital will share our concerns with Lincolnshire Health Scrutiny Committee and will support legal action should it be considered appropriate.
As a further consideration for both South Kesteven District and Lincolnshire County Councils when we asked residents if the planned developments should go ahead if our hospital has no A&E over 99% responding said ‘No’.
Charmaine Morgan is the South Kesteven District Councillor and Chair of SOS Grantham Hospital