|
||||||||
|
||||||||
Critical
Care Unit
Grantham
and District Hospital
101
Manthorpe Road
Grantham
Lincs
NG31
8DG
27.11.06
Mr G Walker
Chief Executive
United Lincolnshire Hospitals NHS Trust
Trust Headquarters
Grantham and District Hospital
101 Manthorpe Road
Grantham
Lincs
NG31 8DG
Dear Mr Walker,
Many members of the nursing staff associated with the critical care unit at Grantham hospital were deeply disturbed by the comments attributed to you in the Grantham Journal article last week, we were disappointed that your comments as Chief Executive representing the trust were factually incorrect and as such we felt that we had to express our point of view.
For over ten years level 3 critical care has been provided by the dedicated team of professionals that are associated with the critical care unit at Grantham. The service was reviewed a few years ago and it was decided that patients requiring more than 24 hours level 3 support would be transferred to more specialist centres. As intensive care has grown as a specialty in its own right some of Grantham’s anaesthetists felt that they lacked specific intensive care skills. The ’24 hour’ rule was problematic in that bed availability at other hospitals resulted on many occasions in delays beyond the 24 hour period – it is widely recognised that there is a shortage of staffed level 3 beds nationally. Patient stability also plays a part in delays – obviously the patient must be stabilised enough to transfer safely and this can take time. There is also a sub-group of patients who may recover within 24-48 hours – if the patient had a realistic prospect of being extubated fairly quickly, and thus return to level 2 classification, clinical decisions were made accordingly.
However the critical care review of 2005 resulted in a requirement for all patients requiring level 3 care to be transferred out of Grantham. In reality this can be difficult to achieve in a short time frame. Amongst the issues are investigations that can take time to organise, for example before accepting a patient a neurology centre will want to see CT scans. Finding an available bed can be extremely difficult and take a considerable amount of time. There is also a need for two different specialties to accept the patient in the receiving hospital, for example a patient requiring surgery and level 3 care must be accepted by both the intensivist and the surgical team again this can be problematic. There is also an issue in terms of which patients will be accepted – clinicians at the end of a telephone have to make decisions about whether to offer a bed or not without seeing the patient, a life or death decision for the individual patient.
In practice we are still providing level 3 care on a regular basis whilst transfers are arranged, both within the critical care department and A&E who call on us for help. In addition patients who require non-invasive ventilation and cardiac support (who meet the criteria for level 3 as defined by the Intensive Care Society) are cared for successfully without transfer. To read in the local press that the trust stand by the statement that critical care at Grantham has never been at level 3 standard is devaluing and distressing for the skilled and professional staff still providing that level of care as and when required (for example twice within the last week). Whilst Grantham operates as an acute hospital there will always be a need for staff who are capable of caring for level 3 patients.
As a team we have continued to provide high quality care for all our patients throughout the turmoil of the last few years when we have been constantly under threat. It is our understanding that a review of the current operational policy is underway and our future continues to be uncertain both in relation to that review and the future of the hospital as a whole. We want to assure you that we are passionate about and capable of providing a high quality service to the patients of Grantham and the surrounding areas.
We ask that we are involved in the discussions around the future of both critical care and the hospital in general, there is a feeling amongst the staff that decisions are being made behind closed doors and that consultants are being induced to support downgrading so that it can be presented as a clinical decision. The points raised by Mike Williams are indeed the issues being talked about at grassroots level within the hospital and are obviously a cause for great concern for both the staff and people of Grantham alike. Rather than leaving us in the dark, relying on what we hear, why not be open and transparent about the discussions taking place about the future of the hospital. The fact that staff are talking to the press surely indicates that it is not only the people of Grantham who are worried and concerned.
And rather than look at downgrading Grantham why not look at the feasibility of rotating consultants between different sites, particularly since it was the reluctance on the part of some of the consultants to support critical care that led to reductions in service – surely it would be easier for the doctor to travel than the patients who are sick and need treatment within the ‘golden hour’, not to mention the implications on the ambulance service, patients relatives, carbon emissions etc.
The nursing staff and allied professionals want to continue caring for patients on the Grantham site – and talking to patients and relatives this is what they want too. We would like to invite you to come and spend a shift with us so that we can demonstrate the high quality of care we provide and so that you can see at first hand some of the issues we face.
Yours sincerely
Critical Care Nurses, Grantham