In the second of a three-part series looking at potential changes to the region’s NHS, Derek Cruickshank, a consultant gynaecological oncology surgeon at Middlesbrough’s James Cook University Hospital, argues that it’s worth travelling further for specialist care, even in an emergency

OVER the last 30 years, we have become used to the idea of going to a specialist hospital to get the best care.

We take it for granted that complex operations, such as heart bypass or spinal surgery, and treatment for rarer cancers may mean we need to travel past our local hospital to a neighbouring town or city to be treated by a specialist consultant.

When I qualified as a consultant in 1993 my colleagues and I practised general gynaecology and obstetrics (maternity) work. Now I only practise as a specialist in gynaecological cancer, along with just one other colleague, covering a population of more than one million people across the Tees Valley area and beyond.

This means we see enough patients to keep up a level of expertise expected in our specialist field – but you probably wouldn’t want me to be in charge of delivering your baby anymore.

Despite our experience of planned care we still tend to think that in an emergency the best care should be available at our local hospital. When most of our hospitals were built they were called district general hospitals because they offered general care for patients in the district. Unfortunately, there is no such thing as a general patient.

We need to recognise that although two hospitals may both have an accident and emergency sign above the door, this doesn’t necessarily mean they offer the same level of care, or the same range of services.

Although most hospitals can provide us with the right care most of the time, over the last ten years more aspects of emergency care have become centralised on fewer sites in order to get the best results for patients and improve survival rates. Medical evidence shows that where emergency patients are admitted to specialist centres with staff who see high numbers of patients with similar problems, outcomes are much improved.

Treatment for patients with serious life threatening injuries is an example of this. The recent national reorganisation of major trauma services onto just 24 sites – including at James Cook University Hospital – produced in its first year a 20 per cent improvement in survival rates. This is despite increased travel time for patients who now bypass A&Es that previously treated only a handful of these very serious and complicated cases.

Effective treatment for stroke requires rapid transfer to a highly specialised unit where stroke can be swiftly diagnosed and drugs can be given to minimise the brain damage that occurs. This can result in a full and swift recovery. Interventions for stroke, similar to those for heart attacks will soon become available in specialist centres.

When heart attacks were treated with bed rest, the survival rate was about 75 per cent. Today, patients are taken by ambulance to the specialist centre at James Cook where we mechanically unblock the artery causing the heart attack. Survival rates have increased to 95 per cent and patients are discharged within days, rather than weeks.

Our clinicians believe that there are other emergency patients who would benefit from treatment in a specialist environment, with senior staff on duty seven days a week. Unfortunately, we can’t do this at all of the hospitals that currently provide A&E. As services are currently organised, we don’t have enough consultants in each of the key specialist areas to staff robust 24 hour a day rotas.

This is a problem nationwide and will be for many years. It takes about 15 years from starting medical school to train a consultant

So what could this mean for our services? We are currently looking in detail at two main scenarios.

James Cook University Hospital would continue to provide major trauma, stroke and heart attack treatment and other specialist emergency services. A second specialist emergency hospital would be then be provided at either the University Hospital of North Tees or Darlington Memorial Hospital.

We can provide care in this way, thanks to the availability of the skilled paramedics of the ambulance service. The role of the paramedic is key to stabilising the patient and beginning treatment even before setting off for hospital. In our rural areas, we also depend on the air ambulance. We recognise that investing in the role of these services will be a vital part in ensuring services work for patients.

Whichever of these two hospitals does not become a specialist emergency hospital would have an enhanced and regional role providing “state of the art” planned surgery, with the expectation of no cancelled operations.

All three of these hospitals will continue to provide urgent care, outpatient care, diagnostics and tests for their local patients. There is a lot more work to do to develop these plans and we will be holding a series of events in the New Year to talk to local people and seek their views.

I hope you will be able to join us.