Manchester Royal Infirmary

Information Department

Cobbett House

Manchester Royal Infirmary

Oxford Road

Manchester

M13 9WL

Tel: 0161 701 0375

Fax: 0161 276 8037

E-mail:

Dear Mr Carter

Thank you for your request for information, received on 6 August 2013. You have asked for the following information:

1. Please provide me with figures for the years 2011-12, 2012-to date, which show attendances at the Accident and Emergency department of Trafford General Hospital.

2011-12

Month / 0 - 15 Years / 16 - 65 Years / 65 + / Total
Apr 2011 / 589 / 2,039 / 670 / 3,298
May 2011 / 583 / 2,132 / 679 / 3,394
Jun 2011 / 575 / 2,073 / 745 / 3,393
Jul 2011 / 604 / 2,215 / 723 / 3,542
Aug 2011 / 493 / 2,071 / 697 / 3,261
Sep 2011 / 537 / 2,096 / 662 / 3,295
Oct 2011 / 516 / 2,091 / 699 / 3,306
Nov 2011 / 596 / 1,892 / 734 / 3,222
Dec 2011 / 524 / 1,993 / 804 / 3,321
Jan 2012 / 474 / 1,951 / 721 / 3,146
Feb 2012 / 535 / 1,874 / 621 / 3,030
Mar 2012 / 742 / 1,994 / 745 / 3,481

2012 -13

Apr 2012 / 507 / 1,976 / 644 / 3,127
May 2012 / 661 / 2,012 / 727 / 3,400
Jun 2012 / 551 / 1,974 / 679 / 3,204
Jul 2012 / 557 / 2,203 / 628 / 3,388
Aug 2012 / 468 / 2,089 / 724 / 3,281
Sep 2012 / 534 / 1,943 / 635 / 3,112
Oct 2012 / 536 / 1,954 / 649 / 3,139
Nov 2012 / 567 / 1,865 / 677 / 3,109
Dec 2012 / 512 / 1,847 / 729 / 3,088
Jan 2013 / 491 / 1,906 / 733 / 3,130
Feb 2013 / 548 / 1,682 / 629 / 2,859
Mar 2013 / 625 / 1,911 / 662 / 3,198

2. Please provide and explain any classifications for such attendances, including their ages, and the number of admissions which resulted.

The age classifications are as defined in the column headers in the tables above. The in-year variation is shown by month within financial year.

3. Please provide details of staffing numbers in the A&E Trafford department and the dependant departments (Intensive Care Unit, Emergency Surgery, Paediatric and Observation Units) for the years 2011-12, 2012-to date.

The numbers of whole time equivalent staff for the A&E and Critical Care Departments for 2011, 2012 and 2013 are given in the table below. These are figures for the numbers of staff in post, and show a high degree of stability on staffing numbers over this period.

The Acute Surgery service is provided by staff from a number of different teams. As such, the Trust does not hold separate staffing figures for this service. Similarly, the Paediatric Observation and Assessment Unit (POAU) service is provided by staff working within the Children’s Centre at Trafford General Hospital. These staff are rotated into the POAU, so it is not possible to provide separate staffing figures for this service.

Whole time equivalent staff / 2011 / 2012 / 2013
A&E / 41.35 / 41.84 / 42.39
Critical Care / 24.23 / 24.34 / 22.87

4. Please provide details of how many patients treated in Accident and Emergency were later admitted to the Intensive Care Unit, Emergency Surgery, Paediatric and Observation Units at Trafford General Hospital, or who were subsequently transferred to other hospitals and which hospitals were they taken to.

Critical Care / Paediatric Observation and Assessment / Acute Surgery
Number of patients admitted from A&E / 43 / 188 / 544

5. Please provide the times taken to transfer these patients to the other hospitals and the availability of beds when they arrived at Trafford Hospital and the receiving hospital they were then sent to, and the wait they endured before they received their treatment.

CMFT does not hold information about the time it takes to transfer a patient to another hospital. As with all other transfers of patients between hospitals, the patient is maintained in a safe environment at Trafford General until such time as they have been accepted for transfer to an alternative hospital and the transport is then organised. Trafford General is surrounded by three large acute Teaching Hospitals (Wythenshawe Hospital Hope Hospital and MRI) which between them offer a very comprehensive range of specialist services. As such, it would be very unusual for patients from Trafford General to transfer further afield. The transfer distances and times to these three hospitals are not significant.

6. With regards to the critical ‘golden hour’ (first hour) of treatment for emergency patients, could you please confirm the accuracy of the statement ‘For every 10 minutes a patient has to wait/travel there is a 20% decrease in life expectancy, i.e. for every 10 minutes = 20%, for 20 minutes = 40%, etc.?

The Trust does not recognise this statement and is not able to offer an opinion on it, other than to observe that it implies a mortality rate of 100% for patients who wait more than 50 minutes, which is patently not the case.

7. Please provide me with the estimated death rate per year if the A&E closes at Trafford between 12.00 – 8.00 a.m. through travel to these other hospitals further afield. - SG

The Trust has not made any projection of changes in death rate, and does not hold any data that relates to this. The NHS uses Hospital Standardised Mortality Rate (HSMR) statistics to compare death rates between hospitals. It is notable that MRI, Wythenshawe and Hope Hospital all have lower HSMR statistics than Trafford General Hospital. One of the reasons for proposing the changes is to ensure that Trafford residents can receive the most effective clinical care, and this would be expected to reduce mortality.

8. Please provide me with the estimated death rate per year if the A&E closes as seems to be the intention through travel to these other hospitals bearing in mind the football traffic around three times a week from Manchester United, plus Manchester City, and the cricket and pop concerts at Lancashire Cricket Club, and other traffic realities like the many road works and other delays like rush hour twice a day that don’t seem to have been properly taken into account.

The A&E service at Trafford will continue to operate during the day, and will only be closed between the hours of midnight and 8.00 am. The Ambulance Service is confident that ambulance vehicles, travelling with a blue light, can access the services that Trafford residents will require on an appropriate timescale.

9. Have all the above scenarios been taken into account when calculating the death toll through travel time whilst sending the local population to these other hospitals further afield and please state each scenario taken into account?

Greater Manchester is an urban area and, as such, regularly experiences disruption to traffic flow for many different reasons, and in many different locations. This is the reality of the environment in which the ambulance service operates. The experience of the ambulance services is that, even when there are difficulties with traffic flows, ambulance vehicles travelling with sirens and blue lights are able to convey patients to hospital in a safe and timely manner. The North West Ambulance service has assessed the proposed service changes and has confirmed that they will be safe.

10. With using the previous five years data please calculate the estimated amount of emergency patients in Trafford that would have died as result of not having an A&E department at Trafford having to go to other hospitals further afield with the realistic traffic delays previously touched on?

As noted in response to Q7, the planned changes are expected to improve the care provided to Trafford residents. It is important to note that the requirement under the Freedom of Information Act is for public bodies to share with the public, on request, relevant information they hold. It does not require public bodies to undertake new analyses, generate new information, or speculate on matters on which there is no existing relevant material that would fall within the ambit of the Act.

11. Please provide me with the estimated death rate per year if the A&E & Intensive Care Unit closes as may be the case through travel to these other hospitals.

12. Please provide me with the estimated death rate if the A&E, Intensive Care Unit and Emergency Surgery Units at Trafford General Hospital close as may be the case through travel to these other hospitals further afield.

13. Please provide me with the estimated death rate if the A&E, Intensive Care Unit and Emergency Surgery and Paediatric at Trafford General Hospital close as may be the case through travel to these other hospitals further afield.

14. Please provide me with the estimated death rate if the A&E, Intensive Care Unit and Emergency Surgery and Paediatric and Observation Units at Trafford General Hospital close as may be the case through travel to these other hospitals further afield.

Please see the answer to question 10 above.

15. With regards to the hospitals further afield who are earmarked to take the full weight of Trafford’s’ Accident and Emergency patients when it is closed already failing to meet their basic guidelines to meet their four hour waiting deadlines what impact do you think another 39.000 people that would usually use the Emergency & Accident from Trafford each year have on those hospitals, their already stretched waiting times and their patients? (39,000 figure is the from a previous Information Request - Matt Finnegan - approximate average amount of people using Trafford A&E up to 2010)

It is important to emphasise that the Trafford A&E Department is not closing. The hours of the service will be restricted to 8am to midnight. Between midnight and 8am the number of patients using the Trafford A&E service is quite limited. During the hours when it is operating (between 8am and midnight), the service will continue to be led by Consultants in Accident and Emergency Medicine, with the full complement of medical and nursing staff one would usually expect to find in an NHS A&E Department. Patients who require the highest levels of care will be taken to one of the three surrounding specialist Teaching Hospitals, where they will be able to receive services that cannot be provided at Trafford. The analysis that has been undertaken suggests that the service at Trafford General Hospital will continue to see about 28 – 29,000 patients per year, with only 9 – 10,000 patients going elsewhere. This volume of patients will be spread around the A&E services of three very large neighbouring hospitals. These hospitals are all currently achieving the A&E performance targets, and each hospital has given an assurance that they will be able to continue to comply with the target under the new service arrangement.

16. Please provide me with a copy and/or access to all reports, minutes and other documents concerning the current and/or future provision of A & E services and the other dependant units stated above at Trafford General Hospital to show the full consideration and impact on Trafford and the surrounding areas the realities of these cuts will have on the lives of the locals who live there and those in the areas further afield who will also be impacted.

All of the key reports and minutes relating to the decisions about the Trafford A&E service are available on the New Health Deal for Trafford website, at:

http://www.healthdeal.trafford.nhs.uk

We hope this information is useful to you and fully answers your request. However, if you are dissatisfied with the management of your request and you wish to make a complaint or request a review, you should write to Mr Gareth Summerfield, Head of Information at the above address.

If you are not satisfied with the outcome of your complaint, you can then ask the Information Commissioner's Office (ICO) to make a decision. Generally the ICO cannot makea decision unless you have completed our internal complaints process. Their contact details are:

Information Commissioner’s Office

Wycliffe House

Water Lane

Wilmslow

SK9 5AF

Telephone: 0303 123 1113

Website: www.ico.gov.uk

Yours sincerely

Nicholas Jones

Information Governance Manager

Incorporating:

Royal Manchester Children’s Hospital ¨Manchester Royal Infirmary ¨Manchester Royal Eye Hospital

¨Saint Mary’s Hospital for Women and Children ¨ University Dental Hospital of Manchester