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I feel that I have to respond to this, not as a healthcare professional with any axe to grind but as a person living in a town of 50000+ ( more during term time as we have 10000 students extra). The town I live in is Loughborough, Leicestershire, our minor casualty unit operates from 9-00am to 5-00 pm Monday to Friday. Outside of this time there is a doctor and one or two nurses, there are no X-ray facilities etc. Our designated A & E department is at the Leicester Royal Infirmary (LRI) 17 miles away, alternative departments are Queens Medical Centre(QMC), Nottingham & Derbyshire Royal Infirmary(DRI), Derby, both also about 17 miles away. A few years back my youngest son had an infantile convulsion and was unconscious, my wife phoned for an ambulance as I was at work, this was about 4-30 in the afternoon. I was phoned at work at about 4-40 and made my way down to LRI where the ambulance on blues finally arrived at 5-30. Our house is five minutes away from the ambulance station, however not one was available there, the nearest was in Sileby about 7 miles away. The crew had to get to Loughborough against evening rush hour traffic, asses, load and go and then fight against the traffic in Leicester. LRI is on the opposite side of the city centre to Loughborough. LRI has to cover the whole of Leicestershire, except parts of the north west of the county which also use the Queen Elizabeth hospital in Burton-on-Trent. (Burton is a town the size of Loughborough and has a large hospital with an A and E dept, although the town is located only 11 miles from Derby, 24 from Leicester, 30 from Stoke, Birmingham and Nottingham.) It was stated that serious cuts don't require a major A & E dept. this may be true, but how many of the general public don't realise this. What about fractures outside of working hours? If an X-ray is required then people have to be diverted to the hospitals listed, where they may have to wait up to 8 hours to be treated. There has to be a priority to put a 24 hour A and E department in every major population centre. Unfortunately the reality is that this is not likely to happen, although I am not as cynical as another list member! :). Without wishing to offend anyone in this position, I do think that there are too many administrators. This was something that my father, an SEN on a geriatric ward for twenty years until his death in 1977, complained about in the 70's when the health service was re-organised. John Collis, Principal Software Engineer and FAW, Racal Defence Electronics Limited, Scudamore Road, Leicester, Leics Tel: 0116 2594253 e-mail: [log in to unmask] corporate website : www.rdel.co.uk -----Original Message----- From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Andrew G Hobart Sent: Sunday, March 26, 2000 22:53 To: [log in to unmask] Subject: Re: Will this money make a difference? S A Hughes wrote: > <[log in to unmask]> writes > > > >> 2. 90% of patients have access to a major A&E unit > >> within 30 minutes' normal road travel (i.e. not a blue-light ambulance); > >> every town of 50,000 or more has a major unit. > > > >Number 2 would be a retrogressive step IMHO. > >All others I agree with in principle. > Andrew, > > Would you care to expand on this? Are you saying that only large > population centres should have an A/E department? > No. How many towns of 50,000 are there? How many of them currently do not have a Hospital never mind a major A&E unit? Quite a few I suspect. How many new A&E departments would be needed to give this degree of access? Is it feasible to staff this number of Hospitals to the level required to have a major unit? I think not. > Why on earth should someone with what they perceive as a nasty cut or or > bony injury face a long drive to a major town with a teaching hospital? > What sort of service will they get? A nasty cut does not need to be treated in a major A&E unit. > The centralisation of health care is a disaster for rural communities, > and from what I've seen in Newham, doesn't do the urban folk much good > either. If you centralise in order to try and do more with less it will be a disaster. If a certain degree of centralisation is accompanied by increased investment then care could be improved. > Are you trying to tell those of us in out of town DGH's that we provide > a poor service? Not at all. But I think our service might get worse if we try to spread ourselves even more thinly than at present. -- Andrew _______________________________________________________ Andrew Hobart FRCS FFAEM Birmingham %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%