One in six A&E departments at risk of closure or downgrade

One in six A&E departments face being closed or downgraded in the next four years, according to an analysis of NHS proposals.

About 33 casualty departments in hospitals in 23 areas of the UK are facing either complete closure or being replaced with minor injuries units.

The plans are part of efforts to plug a £22bn hole in the health service budget by 2021. Health officials insist the changes will come alongside efforts to modernise services and increase specialist urgent care.

In seven cases, proposals have been drawn up, some of which have been issued for local consultation. According to research by the Health Service Journal (HSJ), 26 more hospitals are now considering plans to close or downgrade services but no final decision has been made.

The seven hospitals for which there are public proposals to downgrade or close emergency departments include Sandwell and West Birmingham hospitals trust’s City hospital and Sandwell district general hospital, which are due to be replaced by a new department at the Midland Metropolitan hospital that is scheduled to open in 2018.

The remaining 26 hospitals may have their A&Es downgraded or closed but, equally, they could be kept or upgraded. Decisions are expected to be made between either Shrewsbury or Telford, Bedford or Milton Keynes and Darlington memorial hospital or the University hospital of north Tees.

In total, about 24 of the 33 hospitals under discussion are likely to lose full A&E services, the HSJ said.

The news comes at a time when hospitals are under severe strain. Almost half of NHS trusts declared a major alert in January and record numbers of hospitals have diverted ambulances to other hospitals. The number of life-saving operations cancelled at the last minute has also reached a new high, with more than 4,000 put on hold last year.

An NHS spokesman said: “The number of people seeking urgent care is on the rise so overall we expect the range of services available to them to expand over coming years. Within that overall expansion, it may be possible to improve care and save lives with some concentration of specialist urgent services.”

He said he did not expect significant numbers of A&E changes in the years ahead, with one of the decisions – concerning Sandwell and City hospitals – taken some years ago.

Annual figures show the number of patients stuck on trolleys in A&E units for more than 12 hours has doubled in two years, with a tripling in cases among the elderly.

It has been claimed that one woman died of a heart attack after waiting for 35 hours on a trolley at Worcestershire royal hospital. The hospital’s A&E department has become overwhelmed so often that it has diverted ambulances to other units on 44 occasions since December. Yet the hospital is at the centre of plans by its trust to centralise A&E services and downgrade Alexandra hospital in Redditch.

The King’s Fund’s director of policy, Richard Murray, told the HSJ that the NHS appeared to be “caught betwixt and between”. The number of potential downgrades, he said, “is not high enough to conclude we are seeing a radical redrawing of urgent and emergency care, but it is high enough to suggest a lot of political noise and require a lot of potentially noisy public consultations”.

In November, the Labour leader, Jeremy Corbyn, who grew up in Shropshire, spoke out against plans to close either the emergency department in Shrewsbury or in Telford in what has become a bitter issue locally.

He said: “I want to make sure there are proper A&E facilities across Shropshire. I grew up in Newport and I remember the discussions about opening those A&E departments in the first place. There need to be A&E departments in reasonable reach of everyone’s homes so that, obviously, emergency cases can be dealt with quickly.”

Chris Moulton, vice-president of the Royal College of Emergency Medicine, told the Telegraph the plans were crazy. He said: “Hospitals are under massive pressure, it’s now horrendously common to have 12-hour trolley waits and in some cases 30-hour waits in A&E. The NHS has been desperately short of capacity for the last few years – it’s crazy to close A&E units when there simply isn’t capacity to cope with these patients elsewhere.”

Meanwhile, separate analysis by the BBC has found that the number of people facing longer waits than they should for hospital treatment in England has more than doubled since 2012.

A key target waiting time of 18 weeks is not being met for more than 350,000 patients, resulting in a 163% rise over four years, it was found. The total number of people on the waiting list is 3.7 million. Figures for Wales and Northern Ireland provided by the Royal College of Surgeons show they have also seen a rise.

One in six A&E departments at risk of closure or downgrade

Will the closure of India"s sterilisation camps end botched operations?

It happened in a classroom, on the desks of the village school. It was dark, so the doctor operated on the women by torchlight. The procedure only took two minutes; many women did not even know that they had been permanently sterilised.

That Saturday night, in January 2012, 53 women from the village of Kaparfora in the northern Indian state of Bihar had tubectomies over a period of two hours, under the supervision of a local NGO. The school desks where the operations took place were never disinfected; the doctor never changed his gloves, and the medicines were past their use-by dates, violating a number of government guidelines. After the operations, the doctor left the school, ignoring the wails of the bleeding women in the classroom.

Devika Biswas, a health activist from the region, who visited Kaparfora a month after the event on a fact-finding mission, says she was “aghast” at the conditions she saw. “I was feeling so bad. I thought, is this my country? Not a single woman was screened to see if there would be any complications. One of the women who was sterilised was actually three months pregnant, and she ended up miscarrying her baby. I mean, they were just butchering women.”

Biswas recalls the words of one woman she met in the village. “She looked sad so I asked her to speak her mind. She said to me, ‘The government puts no value on our lives, so they can do anything to us.’”

Biswas filed a petition to the supreme court based on her findings. After a four-year legal battle with the government, this September the court ordered the government to shut down sterilisation camps across India within three years. Though women can still go to health clinics and request to have tubectomies, sterilisation camps run either by state government officials, or outsourced to local NGOs, in which doctors go out to villages and encourage women to have their tubes tied, will be illegal.

The supreme court’s verdict is a historic victory for women’s rights activists who have campaigned against sterilisation camps for decades. The ruling could mean that, for the first time, India moves away from family planning policies that focus on women rather than men and provide a wider range of contraception, particularly in rural clinics.

The judge told state governments to increase compensation payments to victims of botched surgeries. “It is time that women and men are treated with respect and dignity and not as mere statistics in the sterilisation programme,” wrote Justice Madan Lokur in the judgment.

The mother of 30-year-old Phoolbai, who died after she underwent surgery at a government mass sterilisation camp. Photograph: Alamy Stock Photo

India’s controversial sterilisation drives, funded by the World Bank, USAID, and other international organisations have been at the core of the country’s efforts to minimise population growth since the 1980s. Unlike China, where, until last year, a strict one-child policy has slowed population growth, India’s government offers cash incentives to women and men who choose permanent sterilisation in an attempt to bring down the national fertility rate.

Quotas for sterilisation and cash incentives to doctors and village health workers who bring women to camps have led to mass operations – sometimes even on very young women in their early twenties – increasing the risks of infection and poor care. The sterilisation camps became a national embarrassment when 15 women died after botched tubectomies in the northern state of Chhattisgarh.

The focus on permanent sterilisation comes from a long-rooted belief that overpopulation is at the heart of India’s major problems of hunger, poverty, poor education and poor healthcare. India has the world’s second biggest population after China, 1.25 billion people, roughly equivalent to the populations of Europe and North America combined.

While family planning clinics around the country offer free oral contraceptives, IUDs and condoms, these methods are unpopular and associated with promiscuity. Vasectomies, cheaper and easier sterilisation procedures for men, are available too, but the stigma of being unmanly, and the memory of former prime minister Indira Gandhi’s fertility control drives in the 1980s, in which millions of men were forcibly sterilised, have stuck.

India sterilises more women than any other country in the world. “The government’s strategy has always been female-focused,” explains Sarita Barpanda, from the Human Rights Law Network.

“All the programmes are targeted at them. Many women are coerced into having sterilisations. The fact that the government has given so much of the responsibility for sterilisations to private organisations suggests how valuable a woman’s life is.”

Barpanda has further stories of atrocities during the sterilisation drives around the country. “In Orissa, they used bicycle pumps in the operations because the doctors did not have up-to-date medical equipment,” she says. “In Himachal Pradesh, one doctor did five surgeries and then passed out drunk halfway through the sixth. In Malda, in West Bengal, they had no beds for the women, so they had to lie out on the ground, in the cold after the operations,” says Barpanda. “Almost every state was reporting violations of the government’s sterilisation guidelines.”

In 2007, the supreme court ruled that the national government was responsible for maintaining standards in sterilisation procedures. It also asked state governments to introduce quality control commissions to ensure high standards in family planning clinics and camps, but these bodies have not been established.

In a statement to the Guardian, a spokesperson from the Ministry of Health and Family Welfare said the botched sterilisations were “a one-off” and were the exception rather than the rule.

The ministry said it had made many attempts to improve standards at state-run sterilisation camps. “The government of India has formulated several manuals and regular updates for the guidance of the state governments and union territories to address all aspects of conducting sterilisation procedures. The government of India has also issued advisories to all the states and union territories to adhere to the standard operating procedures at all levels to prevent and pre-empt incidents that might adversely affect the health of clients due to sterilisation procedures. These have been extensively disseminated across states.”

Women who underwent sterilisation surgery queue to receive food inside a hospital in the eastern Indian state of Chhattisgarh, in November 2014. Photograph: Anindito Mukherjee/Reuters

The spokesperson said that the supreme court’s decision to phase out sterilisation camps was “in alignment with the government of India’s own endeavour in that direction over a period of three years”.

Contraceptives were being offered free of charge to any couples wanting them, added the spokesperson, and the government is increasing access to family planning.

But Biswas says she doubts the supreme court’s order will make much difference. “The government is responsible – they are perpetual violators of the rights of women in this country, but I just don’t think anything will change.”

Barpanda is more optimistic. “They’ve already stopped the camps in Orissa,” she says. “This was a really big thing for the supreme court to pass. But I don’t know if I would call it a victory because so many people have lost their lives.”

Will the closure of India"s sterilisation camps end botched operations?

Atomic Man Gets Closure at Nuclear Weapons Site

Workers will be entering one particular of the most hazardous rooms at the Hanford Nuclear Reservation in Washington State, the website of a 1976 explosion that exposed a radiation employee named Harold McCluskey to a huge dose of radiation. He survived to become known as the Atomic Guy and the lab was dubbed the McCluskey Room.

Twenty-eight years in the past, the 64-12 months-old McCluskey was operating on columns filled with special exchange resins in a glove box at the Plutonium Finishing Plant utilised to recover radioactive americium, a byproduct of plutonium manufacturing for weapons production.

The laboratory had been closed for 5 months as a consequence of a strike, and McCloskey was wary of resuming this distinct perform, remembering earlier warnings of doing work with resins that have been unattended for that prolonged a time. But his boss said to proceed. Following including nitric acid to columns containing americium (Am-241) and other radionuclides, the column exploded, spraying leaded glass, nitric acid and radioactive supplies onto the encounter of McCluskey.

The radiochemistry laboratory, referred to as the McCluskey Area, in the Plutonium Finishing Plant at the Hanford Internet site in Washington State exactly where Harold McCluskey was contaminated in 1976, and into which workers are now re-coming into to clean-up the mess left-over from that accident. Health physics technician Clay Rowan is shown here taking radiological measurements close to racks of glove boxes comparable to 1 that exploded onto Harold McCluskey that prolonged time ago. Supply: DOE

In seconds, McCluskey obtained 500 instances the volume of radiation regarded as safe above an complete lifetime, 1000′s of times better than anyone contaminated at Fukushima, and higher than numerous of people who responded to Chernobyl.

He was so radioactive that his entire body set off Geiger counters 50 feet away, in accordance to Department of Power and the Tri-City Herald accounts of the accident (Annette Cary, Tri-City Herald). Simply because of these ranges of radioactivity, McCluskey came to be named the Atomic Guy.

McCluskey was only 5 feet from the blast. His protective respirator was torn from his encounter, metal, glass and rubber had been embedded in his skin, nitric acid seared his encounter and eyes, and radioactive particles coated his body and his airways. McCluskey had to be removed from the ambulance by remote manage and transported to a steel-and-concrete isolation tank exactly where he invested the next three weeks minimize off from any individual speak to.

In the course of the subsequent 5-and-a-half months, it was touch and go for the radworker.  McCluskey was physically scrubbed, cleaned up and offered more than 500 injections of trisodium zinc diethylenetriaminepentaacetate, an experimental drug at the time, that aided his physique eliminate the radioactive materials. The accident changed McCluskey’s life and ended his job, although absolutely everyone stated he remained in great spirits all through the recovery.

Since McCluskey received this kind of substantial radiation doses from this accident (cumulative absorbed doses to the bone, bone surface, liver, and lung were 18, 520, 8, and 1.six Gy, respectively – Toohey and Kathren 1995), it was surprising that he did not die from any radiation-induced cancer or other rad-well being effect. He ended up dying at the age of 75 from congestive heart failure as a outcome of a prolonged-standing coronary artery disease.

Although shunning the spotlight, each time McCluskey did communicate about the incident, he deemed it an industrial accident and mentioned he continued to help nuclear energy. The concentrated nitric acid appeared to have harm him a lot much more than the rad.

An investigation into the explosion confirmed that the resin mixture had grow to be unstable precisely as McCluskey feared, and the government lastly settled in 1977 for $ 275,000 plus lifetime health-related expenses. This accident was one particular of individuals unusual occasions that gives a great deal of crucial data on human biological results of radiation, so the government also desired to study him right after he died.

However, according to McCluskey’s wife, Ella, the government balked at paying the settlement. A former teacher and nurse, Ella cleverly informed them they wouldn’t be capable to do an autopsy when he died. They paid up rather rapid right after that (People 1977).  That autopsy showed McCluskey had no proof of pre-cancerous or cancerous lesions.

The Atomic Guy is back in the news since Hanford employees are arranging to total cleaning out the McCluskey Room at the Plutonium Finishing Plant right after all these many years as portion of the complete remediation of the the Plutonium Finishing Plant. It will be one particular of the most tough clean-up operations in the Department’s historical past and will shut the book on Atomic Man.

“About two-thirds of the Plutonium Finishing Plant is deactivated — cleaned out and prepared for demolition,” explained Jon Peschong, an assistant DOE manager in Richland. “Cleaning out the McCluskey Room will be a major phase forward.”

This time, the radworkers will be in new protective gear that will make them seem like the Marshmallow monster in GhostBusters. The billowy, air-filled 1-piece white suits are topped with what looks like a clear, oversized bucket turned upside down more than their heads. A huge innovation of these suits, created at the Idaho Nationwide Laboratory, is comfort, permitting workers to remain longer in these types of environments.

“It creates a micro-setting for staff,” said Mike Swartz, the vice president for the Plutonium Finishing Plant perform for the CH2M Hill Plateau Remediation Company.

By 2016, the McCluskey Space is anticipated to be gone, following most of the Hanford web site into background. But Atomic Guy will reside on in the legends of the website for a extended, long time.

Atomic Man Gets Closure at Nuclear Weapons Site

GP companies are imploding as surgeries "at threat of closure"

He will tell 500 delegates: “We’re forced into supplying conveyor belt care at breakneck pace.

“Ministers disregard this workforce crisis at their peril which seriously dangers leaving individuals bereft of a GP service in some locations.

“I urge politicians to open their eyes and wake up to the reality that general practice is not just in crisis, it’s imploding.”

One practice in Cumbria is facing closure meaning patients would have to cross a lake to reach the nearest GP.

Other folks in inner city places are also below strain and neighbouring practices are too total to get on far more individuals, the BMA stated.

It has emerged that GP practices are underneath this kind of stress they are getting rid of patients from their lists by shrinking their boundaries.

Medical doctors are also struggling ‘burnout’ with older GPs retiring early or turning out to be locums even though youthful medical doctors are shunning general practice to function in hospitals as an alternative, Dr Nagpaul said.

Maureen Baker, chairman of the Royal School of GPs said: “What we are seeing now is a sad consequence of the desperate shortage of GPs in numerous parts of the nation, and many practices are obtaining it tough to locate replacements for people doctors that have retired.

“This is leaving basic practice teetering on the brink of collapse and obtaining a extreme affect on the care we can supply for individuals.

“Family physicians are heaving beneath the strain of increasing patient demand, due to a expanding and ageing population, and plummeting investment.”

GP companies are imploding as surgeries "at threat of closure"

GPs" surgeries "at danger of closure"

He will inform 500 delegates: “We’re forced into offering conveyor belt care at breakneck velocity.

“Ministers ignore this workforce crisis at their peril which critically hazards leaving patients bereft of a GP services in some locations.

“I urge politicians to open their eyes and wake up to the truth that standard practice is not just in crisis, it is imploding.”

A single practice in Cumbria is dealing with closure meaning patients would have to cross a lake to reach the nearest GP.

Other folks in inner city areas are also under stress and neighbouring practices are as well complete to get on much more sufferers, the BMA mentioned.

It has emerged that GP practices are underneath this kind of stress they are removing individuals from their lists by shrinking their boundaries.

Medical professionals are also suffering ‘burnout’ with older GPs retiring early or turning into locums even though younger physicians are shunning common practice to operate in hospitals as an alternative, Dr Nagpaul said.

Maureen Baker, chairman of the Royal School of GPs explained: “What we are seeing now is a unhappy consequence of the desperate shortage of GPs in several elements of the nation, and several practices are finding it difficult to find replacements for individuals physicians that have retired.

“This is leaving general practice teetering on the brink of collapse and obtaining a extreme influence on the care we can offer for individuals.

“Family doctors are heaving under the strain of growing patient demand, due to a expanding and ageing population, and plummeting investment.”

GPs" surgeries "at danger of closure"

Coalition faces revolt more than clause 119 hospital closure law: Politics live blog

Some coalition MPs are anticipated to rebel towards the government nowadays when the Commons votes on “clause 119”, a notably contentious proposal in the care bill. My colleague Denis Campbell has previewed the debate in the Guardian nowadays. Here’s the begin of his story.

About twenty MPs from the coalition parties prepare to rebel on Tuesday against government programs that could leave well-run hospitals in danger of becoming closed if neighbouring ones get into trouble.

Paul Burstow, the former Liberal Democrat overall health minister who is spearheading opposition to the move, said that at least twenty MPs from his party and the Conservatives had indicated that they would not back the ideas in a Commons vote both by voting against or abstaining.

He is searching for to amend clause 119 of the care bill, dubbed the “hospital closure clause”, which as it stands would give a “trust particular administrator” appointed to kind out a failing hospital trust the power to buy changes in the makeup of an additional nearby hospital’s services as component of an total resolution, such as downgrading it or even shutting it.

Polly Toynbee’s column on this is an essential read as well. I will be covering the debate in detail.

Here’s the total agenda for the day.

9.30am: Mark Carney, the governor of the Bank of England, gives evidence to the Commons Treasury committee.

9.30am: Greg Barker, the climate adjust minister, and other people give evidence to the Commons energy committee on the intergovernmental panel on climate change’s 5th evaluation assessment.

12.30pm: MPs commence the debate on the care bill.

I strategy to focus nowadays on the care bill debate. But, as normal, I will also be flagging up any breaking political information, posting summaries with a round-up of all the day’s developments, and highlighting the most intriguing political articles or blog posts on the net.

Even so, I won’t be posting yet again till about 10am. I’ve got to be in a meeting, I’m afraid.

If you want to adhere to me on Twitter, I’m on @AndrewSparrow.

Coalition faces revolt more than clause 119 hospital closure law: Politics live blog

Jeremy Hunt"s "hospital closure" clause prompts cross-party revolt

Wellness secretary Jeremy Hunt proposed the changes soon after the court of appeal ruled he had exceeded his powers in attempting to close components of Lewisham hospital. Photograph: Leon Neal/AFP/Getty Pictures

The government faces a serious cross-celebration revolt this week above ideas that would give the well being secretary and officials he appoints better powers to shut hospital accident and emergency departments and other services.

The problem is politically explosive, with campaign groups – such as 38 Degrees – warning all MPs that hospitals in their constituencies could be vulnerable to sudden cuts or even closure in the runup to the 2015 general election.

Ahead of what could be a heated Commons debate, a Lib Dem former wellness minister, Paul Burstow, has tabled amendments to the care bill that are likely to be backed by Labour and some rebel Tory MPs.

They dread the powers would let popular and successful services to be closed or downgraded inside forty days, with no appropriate public consultation.

The controversial Clause 119 was inserted into the bill after overall health secretary Jeremy Hunt was advised by the court of appeal final 12 months that he had acted past his authority in attempting to minimize emergency and maternity services at Lewisham hospital in south London.

The proposed alterations had been element of a shakeup proposed soon after the neighbouring South London Healthcare trust went into administration, with losses of far more than £1m a week. Opponents of the cuts at Lewisham argued that their profitable hospital must not suffer following failings elsewhere. Hunt mentioned providers would be delivered ideal if reorganised over a wider region.

Now Labour as properly as Lib Dem MPs and Tory rebels are insisting on appropriate consultation with nearby medical professionals and services users just before adjustments are created to productive hospitals.

Clause 119, dubbed the “hospital closure clause” by critics, gives powers to a “trust specific administrator”, appointed to a financially failing believe in, to suggest changes across a region. Labour well being spokesman Jamie Reed has signed an amendment put forward by Burstow to require much more consultation and give physicians who commission providers a veto above any reorganisation that follows failure in a separate hospital.

Nick de Bois, Tory MP for Enfield North, who fought a lengthy battle for his regional hospital, mentioned he would not be backing the government: “My constituents have witnessed first hand the flawed, unrepresentative consultations on the future of Chase Farm hospital … I have no intention of voting for a clause that reduces further the voice of patients and residents.”

Shadow well being secretary Andy Burnham said: “It is arrogance in the intense for Jeremy Hunt to ask parliament to give him powers that the high court refused. No hospital in England is secure from this power grab, which would permit funds-driven hospital closures to be imposed on any community. With so a lot of hospitals in economic difficulty, this move will send a chill via each local community in the nation.”

Burstow explained that if a hospital was failing badly, ministers ought to have a “rapid way of assessing the alternatives and repairing the issue”. Even though he accepted that providers provided by 1 hospital have been portion of a internet that linked them to other people nearby, ” the alterations deliver hospitals that are not failing into this fast procedure”. “It is crucial that clinicians and the public are completely concerned, and that is what my amendment is striving to repair.”

A Department of Wellness spokesperson explained: “The NHS is at the moment turning round a variety of hospitals in particular measures, several of which have had deep-seated difficulties for many years.

“In extremis, when a trust goes into administration, it is needed to give the administrator ample energy to consider the difficult choices essential to make sure sufferers get protected care. In such situations lives are put at threat if the difficulty is not dealt with swiftly.”

Jeremy Hunt"s "hospital closure" clause prompts cross-party revolt