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Save The Mid Report Into Minor Injury Review & Health Services In Mid Ulster

This document was created post the acceptance of a report carried out by Deloitte in April 2011.

Save The Mid 2011: ref stm/00/1002

Contents

Foreword Page 2 Section 1, Request to Health Minister & CEO of NHSCT Page 3 Section 2, Summary of Findings from section 2.1 of Deloitte Report Page 6 Section 3, Summary of Findings from section 2.3 & conclusion of Deloitte report Page 7 Section 4, Performance of Ambulance Service during test period Page 9 Section 5, Performance of Network hospitals A&Es during test period and present Page 10 Section 6, Comprehensive Spending Review findings page 15 Section 7, Deloitte Touch Risk Assessment 2006 findings page 16 Section 8, Developing Better services Findings page 18 Section 9, Recommendations from Save The Mid page 22 Appendix 1, Full Deloitte Review Report Of Minor Injuries Units page 23 Appendix 2, Full List of Ambulance Bypass protocols for Mid Ulster Hospital - page 41 Appendix 2.1, Freedom Of Information on ambulance response times page 61 Appendix 3, Freedom Of Information to CSR 2008 page 66 Appendix 3.1, EQIA reference and staff memo NHSCT on CSR 2008 page 106 Appendix 3.2 CSR 2008 responses page 109 Appendix 4, Developing Better Services, What is a local hospital, page 117 Appendix 5, Historical reference to ensure that extra beds were made available when removing the Mid Ulster Hospital services page 119 Appendix 6, Mid Ulster Health Facts 2010, page 125 (note Mid Ulster had acute services when these figures were taken)

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Foreword
Thank you for taking the time to receive and read Save The Mids review into the Deloitte Review of Minor Injury Unit provision, unfortunately like many of its predecessors the Deloitte Report was fatally flawed both in its recommendations and in its mathematics. Historically Save The Mid can cite 3 documents that were flawed in their objectiveness & used to remove the Mid Ulster Hospital of acute services: Developing Better Services 2001 Deloitte Touch Risk assessment 2006 CSR 2008 Each of the above documents relied heavily on the subjections of the authors; it would merely seem that the past reports were written to surround a problem that Health Chiefs had already created. What will follow through each section is a breakdown of the Deloitte Review with intermittent summaries from Save The Mid. The bulk of the document is made of the appendixes which are supporting Government Documents. From Section 6, for research based activity, there is further reading regarding another Deloitte report carried out in 2006, the Comprehensive Spending review in 2008 and Developing Better Services, all of which show the malicious run down of the once great Mid Ulster Hospital. Also a historical reference of Government Documents citing the need for more hospital beds within the NHSCT. This report will also be submitted to the health Review team led by CEO of HSCB John Compton.

To be noted all information comes from Government Documents.

Hugh Mc Cloy - Chair Save The Mid Email: hughmccloy@googlemail.com Tel: 07871503189

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Section 1 Request To Health Minister & CEO OF NHSCT. When the A&E was removed in May 2010 and at the request of the Health Minister a feasibility study was carried by Deloitte. Although in its recommendations it said that Mid Ulster did not require extended opening hours, Save The Mid believes this to be fundamentally flawed. Reasons: The report was solely based on a period of 100 days of part-time A&E 2009 9am11pm and Minor Injury Unit 2010 9am-5pm. There were a significant number of ambulance bypass protocols diverting patients from Mid Ulster to other Hospitals, who could have been treated at the Mid Ulster hospital site 2009. The summer months are historically the quietest time at any health facility and bear no significance to the remainder of the year. The public were still unaware of what a minor injury unit could provide and went to other acute facilities. Ambulance response times were on average 44% for the test period to arrive for Mid Ulster Patients (see section 4). The A&Es at network hospital were and are struggling to with the demand placed upon them. The extended opening hours at the Minor Injury Unit is not dependent upon the availability of doctors or consultants. What will follow is a breakdown of the information given within the report to highlight usage by Mid Ulster residents in the test periods. If you agree with the report and wish for extended opening hours at the Mid Ulster Minor Injury Unit, please complete the letter and return to Save The Mid or send it directly to Health Minister Edwin Poots. The Health Minister and CEO of the NHSCT will be furnished with a copy of this report so that they can make direct answers to each respondent. Hugh Mc Cloy 2 Hmannond Street Mews Moneymore BT45 7PU

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Mr Edwin Poots Castle Buildings Stormont Belfast BT4 3SJ

Dear Edwin Poots, I signed below have read and agree with the recommendations as cited by Save The Mid to extend the opening hours at the Minor Injury Unit at the Mid Ulster Hospital Magherafelt. We recognise that the report that is currently accepted by the CEO of the Northern Health & Social Care Trust, Sean Donaghy, to be compromised in its objectivity, and at your soonest convenience raise these issues with the Northern Health & Social Care Trusts Executive Board members.

Yours, (Print Name)

(Signature) (Date)
Youre Address:

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Sean Donaghy The Cottage 5 Greenmount Avenue Ballymena County Antrim BT43 6DA

Dear Sean Donaghy, I signed below have read and agree with the recommendations as cited by Save The Mid to extend the opening hours at the Minor Injury Unit at the Mid Ulster Hospital Magherafelt. We recognise that the report that is currently accepted by Northern Health & Social Care Trust, to be compromised in its objectivity, and at your soonest convenience raise these issues with the Northern Health & Social Care Trusts Executive Board members.

Yours, (Print Name)

(Signature) (Date)
Youre Address:

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Section 2 Scrutiny of Finding in Section 2.1 of the Deloitte Touch report (see appendix 1) 1. Using tables 2.1, 2.3, 2.4, 2.5 &2.9 of the Deloitte Report; we can state that for the period of MayAugust 2009 4,612 Mid Ulster patients required out of hours treatment at acute facilities out of hours 1 2. Of the 4,612 patients requiring out of hours treatment, 3,184 (69%) of these patients required Minor Injury Treatment, for the period May-August 2009 3. Of the 4,612 patients requiring treatment May-August 2009, 2,852 (56%) of these patients were treated at the Mid Ulster Hospital site2,3. 4. The remaining 2,030 patients between May-August 2009 were treated at Antrim Area Hospital, Causeway Hospital, Craigavon Hospital and South Tyrone Health Centre 4, 5 5. Using tables 2.1, 2.3, 2.4, 2.5 &2.9 from the Deloitte report; we can state that for the period of MayAugust 2010 3,411 patients from Mid Ulster required out of hours treatment at A&Es 4, 5 6. Of the 3,411 patients requiring treatment, 1,796 (53%) patients from Mid Ulster required Minor Injury Treatment between May-August 2010 4 , 6 7. There was a reduction of 1,201 patients from Mid Ulster requiring Treatment at acute A&s between May-August 2009 in comparison to May-August 2010 7 Summary Taking into account the fundamental objections by Save The Mid in Section 1 we find these results alarming in that although there is still a demand for out of hours treatment the Deloitte Report declined to recommend extra opening hours for the Mid Ulster site, there is also a large demand for acute treatment: May-August 2009 1,760 Mid Ulster patients, on average 18 patients a day, required Acute treatment in A&E 4 May-August 2010 1,615 Mid Ulster patients, on average 16 patients a day, required Acute treatment in A&E 4 May-August 2009 526 Mid Ulster patients were given acute treatment at the Mid Ulster A&E 2 , 4 Over the 100 day test period on average: May-August 2009 on average 18 Mid Ulster patients required Acute treatment a day during out of hours
3

May-August 2010 on average 16 Mid Ulster patients required Acute treatment a day during out of hours
3

May-August 2009 on average 5 Mid Ulster Patients required Acute Treatment that was given at the Mid Ulster Hospital site our of hours 2,4 There also seems to be no explanation as to why there was a reduction of patients in the test period of some 1,201. For such a figure it would expect some notes would be made about this
1 2

Out of hours defined as the period between 5:00pm to 9:00am May-August 2009 the Mid Ulster Hospital was open from 9:00am to 11:00pm as an acute A&E 3 May-August 2009, Ambulance bypass protocols were in place to stop children under 14; pregnant woman & trauma patients from being treated at the Mid Ulster Hospital A&E 4 Does not include Mid Ulster patients treated at other hospitals in Northern Ireland 5 South Tyrone Health Centre open from 9:00am to 9:00pm 6 Mid Ulster A&E closed 26th May 2010, Minor Injury Unit open from 9:00am to 5:00pm 7 At Mid Ulster Hospital, Antrim Area Hospital, Causeway Hospital, Craigavon Hospital, South Tyrone Health Centre

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Save The Mid 2011: ref stm/00/1002 Section 3 Scrutiny of finding in section 2.3 Of Deloitte report (see appendix 1) For the sake of this section Deloitte focus solely on out of hours Minor Injury Treatment for Mid Ulster patients. 1. Table 2.10 of the Deloitte report is flawed as it makes a comparison including Mid Ulster, to objectively review operational changes, Save The Mid enforce this amendment and remove Mid Ulster stats from the table. This change is reflected in figures 3A and 3B (page 10) 6 2. Table 2.10 includes Minor Injury patients from Mid Ulster who were not recognised in section 2.1 of the Deloitte report. 60 for May-August 2009 & 68 for May August 2010. This is a fundamental flaw in the objectiveness of the review. As these figures were omitted from the earlier calculations by Deloitte 3. The removal of Acute services at Whiteabbey had little change with a net difference of of -245 patients used other hospitals for minor injury treatment during out of hours times in the test period , Scrutiny of Conclusions of Deloitte (appendix 1) a) Section 3.1 of the Deloitte Report cited a reduction of Minor Injury Patients at Mid Ulster site, this was to be expected as out of hours services were not in existence and recommended that neither Mid Ulster nor Whiteabbey required extended Minor Injury Opening Hours, and this did not factor the pressures that other Network Hospitals were facing. b) They based their assumptions on flawed mathematics, the amount of patients requiring just Minor Injury Treatment out of hours originating from Mid Ulster raised from 918 patients traveling from Mid Ulster to network hospitals in 2009 to 1,864 patients during the test period of 2010. The report cited a reduction of patients. c) Whiteabbey had a negative effect on patients using network hospitals out of hours, there were 245 fewer patients originating from Whiteabbey in the test period out of hours. d) using points 3a) & 3b), there was a net increase of 1,619 patients extra out of hours using network hospitals during the test period. Deloitte cited a reduction in their flawed calculations. e) They stated 1 per hour arriving at network hospitals from Mid Ulster; Deloitte based this figure on a 24 hour day, 7 days a week. these figures should be based on the out of hours baseline figure from the previous year; 100 days x 24 to give 2400 hours, 2400 was then divided into baseline number of patients 1,864 to give .0777 patients per hour or to 1 decimal point 1 patient per hour The figure should only have included 48 hours for the weekend & weekdays 5 to 11 as cited in table 2.1 of the Deloitte (appendix 1) report. 72 weekdays 5 to 11 = 72x6= 432 28 weekend days = 28x24= 642 432+642= 1,104 hour 1864 patients divided by 1,104 hours = 1.688 patients per hour out of hours at Antrim A&E

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Save The Mid 2011: ref stm/00/1002 Summary

The extra patients per hour at network hospitals should read 2 per hour, and in most Antrim Area was the place of destination, the report was again flawed in that it did not take into consideration the already overcrowded Antrim Area Hospital (section 5) Out of Hours patients originating from Mid Ulster led to 1,864 (see figures 3A & 3B) patients traveling from Mid Ulster to other network hospitals, equating to on average 186 patients a day during the hours of 5pm to 9am, bank holidays & weekends. Section 5 will prove that network hospitals were already facing severe pressures and could not safely deal with the extra demand.

Figure 3A, Copied from Deloitte Report 2011 24 May August 2009 24 May August 2010 Net Difference Net Difference: Patients Per Day

361 806 445 4.45 Antrim Area 152 363 211 2.11 Causeway 126 286 160 1.6 Craigavon 219 341 122 1.22 South Tyrone 4 4 0 0 Mater 32 28 -4 -0.04 Belfast City 24 36 12 0.12 Royal Group 918 1864 946 9.46 Total Figure 3B, table to show net change in out of hours attendances origination from Mid Ulster: Source Deloitte / Information Department, Health & Social Care Board 1 2 3 4 5 8|Page

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Performance of Northern Ireland Ambulance Service & Ambulance Bypass protocols (see appendix 2) Ambulance response times were not factored into the health & safety aspect of recommending that Mid Ulster Hospital did not gain extra opening hours, this too was apparent in the Comprehensive Spending Review 2008 which is featured in Section 6. Figure 4A, ambulance response times in Mid Ulster (see appendix 2)
Category A Total Calls Total Responses At Scene In 8 mins 66 50 65 51 232 Total Responses At Scene In 8 mins % Responded In 8 mins Category C Total Calls Total Response At Scene In 8 mins 106 120 114 123 463 Total Responses At Scene In 8 mins % Responded In 8 mins

2010 May June July Aug Total Category C

131 125 140 130 526 Total Calls

50% 40% 46% 39% 44% % Responded In 8 mins

2010 May June July Aug Total All Categories

296 324 306 283 1209 Total Calls

36% 37% 37% 43% 38% % Responded In 8 mins

2010 May June July Aug Total

72 59 51 60 242

20 20 22 25 87

28% 34% 43% 42% 36%

2010 May June July Aug Total

499 508 497 473 1977

192 190 201 199 782

38% 37% 40% 42% 40%

Mid Ulster during the test period, May 2010-August2010 had an over average of 40% of calls to the ambulance service responded to in under the targeted 8 minute deadline, as set for acute injuries Category B has a target of 21 minutes & Category C has a target of 1 hour at Local Government Level, these categories would normally be used in cases of Minor Injuries Summary There is a gross lack of public transport for patients from Mid Ulster to avail of during out of hours, weekends and bank holidays, if they are in need of treatment for Minor Injuries they will be left waiting unacceptable times for ambulance transport. This could have been a contributing factor as to why more patients did not go to hospital instead choosing to stay at home and possibly suffer their injury. Meningitis, stroke, heart attacks and asthma attacks are medical conditions that require swift action to prevent death or disability, residents in Mid Ulster are not be served on an equitable basis with the rest of Northern Ireland in regards to life saving acute care or minor injury care.

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Save The Mid 2011: ref stm/00/1002 Section 5

Performance of Network Hospitals, as defined in the Deloitte Report April2011 To give an objective view into how the removal of services affected network hospitals, the summary below is exclusive of waiting times for Mid Ulster & Whiteabbey A&Es and Minor Injury Units, as these are minor injury units that have a 100% rate, to use these would only give a false statement of accuracy, unfortunately the NHSCT and DHSSPS still use the Mid Ulster & Whiteabbey figures to make waiting times within the NHSCT on paper look better. Summary of findings of the overall attendances at Network Hospitals. Antrim Craigavon Mater Belfast City Mater South Tyrone Causeway Royal Group Hospitals
Month Increase In Test Period Patients Waiting 4 to 12 Hours may-August 2009/10 +1,042 +1,385 +666 +1,816 Increase Between May-August 2009/11 Patients Waiting 4-12 hours +1,153 +2,338 +1,290 +2,429 Increase In Test Period Patietns waiting 12 hours or More 2009/11 +586 +184 +108 +126 Increase Between May-August 2009/11 Patients Waiting 12 hours or more +747 +746 +249 +177

May June July August

NOTE, summer months are historically the quietest times in A&E activity Summary

The Deloitte report did not take into account the severe pressures that network hospitals were under as shown in the table above. This fundamentally flaws the Deloitte Report as Antrim Area Minor Injury is only open to 11pm. It also did not take into consideration the full implementation of Developing Better Services; the downgrading of the Mater Hospital & Lagan Valley as associated risks as per the Deloitte Touch Risk Assessment in 2006, where it stated it was a high risk to shut Mid Ulster without expansion elsewhere.. The report currently does not factor in the decision to downgrade Downe Hospital and Belfast City Hospital as associated risks.

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Patients waiting 12 hours or more May- 09 May-10 May-11 Net difference in Net difference test period 09/10 per day test period 09/10 Net Difference 09-11 Net difference per day 09/11

Antrim Area Causeway Craigavon South Tyrone Mater Belfast City Royal Group Total Patients waiting 12 hours or more

0 1 2 0 15 0 13 31 Jun- 09

240 13 1 0 115 72 176 617 Jun-10

448 25 0 0 131 25 149 778 Jun-11

240 12 -1 0 100 72 163 586

8 0 0 0 3 2 5 19

448 24 -2 0 116 25 136 747 Net Difference 09-11

14 1 0 0 4 1 4 24 Net difference per day09/11

Net difference in Net difference test period 09/10 per day - test period 09/10

Antrim Area Causeway Craigavon South Tyrone Mater Belfast City Royal Group Total Patients waiting 12 hours or more

1 0 0 0 3 5 6 15 Jul- 09

0 1 0 0 113 33 52 199 Jul-10

539 101 0 0 58 6 57 761 Jul-11

-1 1 0 0 110 28 46 184

0 0 0 0 4 1 2 6

538 101 0 0 55 1 51 746 Net Difference 09-11

18 3 0 0 2 0 2 25 Net difference per day 09/11

Net difference in Net difference test period per day - test period 09/10

Antrim Area Causeway Craigavon South Tyrone Mater Belfast City Royal Group Total Patients waiting 12 hours or more

0 0 0 0 0 0 1 1 Aug-09

24 4 0 0 35 5 41 109 Aug-10

94 46 0 0 15 1 94 250 Aug-11

24 4 0 0 35 5 40 108

1 0 0 0 1 0 1 3

94 46 0 0 15 1 93 249 Net Difference 09-11

3 1 0 0 0 0 3 8 Net difference per day 09/11

Net difference in Net difference test period 09/10 per day 09/10

Antrim Area Causeway Craigavon South Tyrone Mater Belfast City Royal Group Total

0 0 0 0 4 0 0 4

11 14 1 0 95 0 9 130

108 39 0 0 7 1 26 181

11 14 1 0 91 0 9 126

0 0 0 0 3 0 0 4

108 39 0 0 3 1 26 177

3 1 0 0 0 0 1 6

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Patients waiting 412 hours May- 09 May-10 May-11 Net difference Net difference in test period per day test 09/10 period 09/10 Net Difference Net difference 09-11 per day 09/11

Antrim Area Causeway Craigavon South Tyrone Mater Belfast City Royal Group Total Patients waiting 412 hours

1136 429 606 0 582 1068 2051 5872 Jun- 09

2068 364 898 0 950 1054 1580 6914 Jun-10

1391 662 1321 1 872 916 1862 7025 Jun-11

932 -65 292 0 368 -14 -471 1042

30 -2 9 0 12 0 -15 34

255 233 715 1 290 -152 -189 1153

8 8 23 0 9 -5 -6 37

Net difference Net difference in test period per day test 09/10 period 09/10

Net Difference Net difference Test period per day 09/11 current 09-11

Antrim Area Causeway Craigavon South Tyrone Mater Belfast City Royal Group Total Patients waiting 412 hours

982 329 266 0 553 710 1435 4275 Jul- 09

1071 291 857 0 1019 880 1542 5660 Jul-10

1431 604 1113 0 767 922 1776 6613 Jul-11

89 -38 591 0 466 170 107 1385

3 -1 20 0 16 6 4 46

449 275 847 0 214 212 341 2338

15 9 28 0 7 7 11 78

Net difference Net difference in test period per day test 09/10 period 09/10

Net Difference Net difference 09/11 per day 09/11

Antrim Area Causeway Craigavon South Tyrone Mater Belfast City Royal Group Total

1058 462 262 0 540 491 2092 4905

1506 399 649 0 1107 734 1176 5571 Aug-10

1612 726 1203 0 645 618 1391 6195 Aug-11

448 -63 387 0 567 243 -916 666

14 -2 12 0 18 8 -30 21

554 264 941 0 105 127 -701 1290

18 9 30 0 3 4 -23 42

Patients waiting 4- Aug-09 12 hours

Net difference net difference in test period per day

Net Difference net difference 09-11 per day

Antrim Area Causeway Craigavon South Tyrone Mater Belfast City Royal Group Total

1110 420 363 0 676 748 896 4213

1494 496 811 0 884 766 1578 6029

1498 769 1508 0 545 598 1724 6642

384 76 448 0 208 18 682 1816

12 2 14 0 7 1 22 59

388 349 1145 0 -131 -150 828 2429

13 11 37 0 -4 -5 27 78

Ref: DHSSPS

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Total Patients May- 09 May-10 May-11 Net difference Net Difference Net Difference Net difference in test period Patients per day 09-11 patients per day 09/10 - test period 09-11 09/10

Antrim Area Causeway Mid Ulster Whiteabbey Craigavon South Tyrone Mater Belfast City Royal Group Total Total Patients

5763 3602 1646 1813 6279 1419 3497 3894 8471 36384 Jun- 09

6052 3892 1029 1097 6427 1675 3688 3746 7421 35027 Jun-10

6286 3834 n/a n/a 6372 1720 3567 3713 9049 34541 Jun-11

289 290 -617 -716 148 256 191 -148 -1050 -1357

10 10 -21 -24 5 9 6 -5 -35 -45

523 232 n/a n/a 93 301 70 -181 578 -1843

17 8 n/a n/a 3 10 2 -6 19 -61

Net difference Net Difference Net Difference Net difference in test period Patients per day 09-11 patients per day 09/10 - test period 09-11 09/10

Antrim Area Causeway Mid Ulster Whiteabbey Craigavon South Tyrone Mater Belfast City Royal Group Total Total Patients

5623 3585 1724 1781 6235 1575 3520 3746 7615 35404 Jul- 09

6228 3882 n/a n/a 6248 1638 3649 3696 8922 34263 Jul-10

6098 3665 n/a n/a 6069 1691 3434 3554 8856 33367 Jul-11

605 297 n/a n/a 13 63 129 -50 1307 -1141

20 10 n/a n/a 0 2 4 -2 44 -38

475 80 n/a n/a -166 116 -86 -192 1241 -2037

16 3 n/a n/a -6 4 -3 -6 41 -68

Net difference Net Difference Net Difference Net difference in test period Patients per day 09-11 patients per day 09/10 - test period 09-11 09/10

Antrim Area Causeway Mid Ulster Whiteabbey Craigavon South Tyrone Mater Belfast City Royal Group Total Total Patients

5498 3911 1597 1652 5846 1346 3297 3540 7628 34315 Aug-09

6185 4043 n/a n/a 5728 1490 3645 3578 8189 32858 Aug-10

6063 4045 n/a n/a 5812 1628 3381 3484 8133 32546 Aug-11

687 132 n/a n/a -118 144 348 38 561 -1457

23 4 n/a n/a -4 5 12 1 19 -49

565 134 n/a n/a -34 282 84 -56 505 -1769

18 4 n/a n/a -1 9 3 -2 16 -57

Net difference Net Difference Net Difference Net difference in test period Patients per day 09-11 patients per day - test period 09-11 984 339 n/a n/a 109 233 258 396 1625 787 33 11 n/a n/a 4 8 9 13 54 26 876 214 n/a n/a 41 364 -10 199 1620 147 28 7 n/a n/a 1 12 0 6 52 5

Antrim Area Causeway Mid Ulster Whiteabbey Craigavon South Tyrone Mater Belfast City Royal Group Total

5183 3770 1491 1666 5898 1325 3373 3288 6960 32954

6167 4109 n/a n/a 6007 1558 3631 3684 8585 33741

6059 3984 n/a n/a 5939 1689 3363 3487 8580 33101

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Save The Mid 2011: ref stm/00/1002 Summary The months of May, June, July & August are used as these are the test months Deloitte used. Between May-Aug 2009 to May-Aug 2010 Mid Ulster network hospitals seen a net increase of 1,004 patients waiting over 12 hours for treatment in A&E, on average an increase of 8 patients a day since the removal of acute services at the Mid Ulster Hospital site.. Between May-Aug 2010 to May-Aug 2011 Mid Ulster network hospitals seen a net increase of 1,919 patients waiting over 12 hours for treatment in A&E, on average an increase of 15.6 patients a day since the removal of acute services at the Mid Ulster Hospital site. Between May Aug 2009 to May Aug 2010 Mid Ulster network hospitals seen a net increase of 4,612 patients waiting 4 to 12 hours for treatment in A&E, on average an increase of 38 patients a day since the removal of acute services at the Mid Ulster Hospital site. Between May Aug 2009 to May Aug 2011 Mid Ulster network hospitals seen a net increase of 7,270 patients waiting 4 to 12 hours for treatment in A&E, on average an increase of 59 patients a day since the removal of acute services at the Mid Ulster Hospital site. Between May-Aug 2009 to May-Aug 2010 at Mid Ulster network hospitals there was a net decrease of -3,168 patients attending the A&Es, on average 26 less patients a day since the removal of acute services at the Mid Ulster hospital site. Between May-Aug 2009 to May-Aug 2011 at Mid Ulster network hospitals there was a net decrease of -5,502 patients attending the A&Es, on average 45 less patients a day since the removal of acute services at the Mid Ulster hospital site.

The overwhelming evidence supports the theory that network hospitals were not prepared for the removal of acute services at the Mid Ulster hospital site and despite a drop of 45 patients a day at these hospitals there were increase in patients waiting over 12 hours and 4-12 hours for treatment. This was not factored into the Deloitte report and as of yet has to be addressed openly by the DHSSPS, the waiting times are exclusive of time spent in the Medical assessment area at Causeway hospital and short stay ward at the Antrim hospital.

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Save The Mid 2011: ref stm/00/1002 Section 6 Comprehensive Spending Review 2008 Introduction Like the Deloitte Report 2011, we find a very questionable if not fraudulent document, in Appendix 3 we see the 12 written responses to the CSR that relate to the reconfiguration of Mid Ulster & Whiteabbey Hospitals. In a letter to staff post the CSR 2008 stated;

The need to make these changes in the interest of safe and sustainable services means that the proposals could be phased from an early date in the current year, commencing first with the changes taking effect at Whiteabbey Hospital. However, there is a need to increase capacity at Antrim Area Hospital before these changes can be implemented. A temporary ward is planned at Antrim to facilitate the changes from Whiteabbey (expected about Jan 2010) and a new permanent ward block (likely to take 2 to 3 years to complete) will create the capacity at Antrim Area Hospital to enable changes at Mid Ulster Hospital. According to the Consultation based on health &safety, Whiteabbey was to be downgraded in January 2010, with Mid Ulster to follow when new buildings had been built at Antrim Area Hospital. This did not happen as per directions given to staff, Whiteabbey remained opened until May 2010 and the reconfiguration of Mid Ulster was brought forward to the same date. The date to close both acute facilities was decided was September 2009, in a meeting with former CEO of The Northern Health and Social Care Trust Colm Donaghy. This decision was then hidden from the public until after the Westminster elections in April 2010 by civil servants. Who by their action prejudiced the outcome of the elections and should be noted for doing so. There were in total 533 responses to the document (see appendix 3.1), however there were only 12 written responses pertaining to the reconfiguration of Mid Ulster & Whiteabbey Hospitals

The consultation document, named Modernising Acute Services had a response from a 24 year veteran worker of Mid Ulster who severely questioned the Northern Health & Social Care Trust on several lies they had portrayed to the public, quotes from the letter; Neither Whiteabbey nor Mid Ulster Hospitals have training status so cannot employ junior Doctors in training. This is translated in the later document to Both Whiteabbey and Mid Ulster Hospital restricted medical training status and as such cannot employ Junior Doctors in the same way that other acute hospitals do this is not correct we have as you know training posts for F1, F2, ST1, ST2 and ST3 doctors at Mid Ulster and have consistently good reports from training inspections/surveys in recent years. The statement Junior Doctors employed at Antrim and causeway hospitals cannot be part of rotas to staff Whiteabbey and Mid Ulster Hospital is not correct. This already happens. To say that there is -no out of hours anaesthetic cover at Mid ulster is not correct

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Section 7

Deloitte Risk Assessment 2006 This risk assessment was used to: Remove inpatient maternity services from the Mid Ulster Hospital Restrict the A&E to opening hours of 9 am to 11pm Introduce ambulance bypass protocols stopping patients from being taken to the Mid Ulster Hospital What were the main risks? A&E: Not sufficient out of hours services to meet RCSI guidelines Anaesthetics: Relied on locum cover Radiology: Consultants were based at Antrim Obstetrics & Gynaecology: Weekend consultant cover was locum Paediatric cover not available General Medicine: Not direct risk other that high work load and need to increase staff Detailed Scoring of risks however showed the high risk of removing services at Mid Ulster without adequate investment being made in network hospitals. Of the 5 different options as highlighted by the risk assessment we now are in the option 5 Local Hospital, which scored 5 (highest risk) for the inability of other network hospitals to manage additional activity. Why when the highest risk to patients was downgrading Mid Ulster before other hospitals were developed was Mid Ulster closed? See next page for ranking of risks that specifically state the full implementation of Developing Better Services was the most high risk option, not just for Mid Ulster patients but also for patients that use the network hospitals.
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Save The Mid 2011: ref stm/00/1002 Section 8

Developing Better Services Developing Better Services was born of the Review of Acute Hospital review Group launched in 2000 by the then Health Minister Barbrie De Bruin. It was later signed off as a strategy for the future by Des Brown of the Labour party as the Assembly was suspended. When the assembly resumed the implementation of Developing Better Services began in earnest with the removal of acute services in Omagh. The validity of this report is questionable by its own admittance (see next page for exact statement) in that the review team were not allowed to objectively review where hospitals should be placed to best serve the population of Northern Ireland. The very Location of Antrim Hospital was questioned but as Dr Hayes was told prior where these hospitals had to be located, the Acute Review is null and void in terms of its objectiveness to patient safety The validity of ever thinking to remove one of the two fully acute inpatient Hospital in Northern Ireland has never been fully addressed (page 17). More so in terms of what this fully acute 180 bedded hospital was to be replaced with. Indeed when this report was written it was previously stipulated that no person should live 45 minutes away from an acute facility, after this report it is now stipulated that no resident should live over an hour away from an acute facility. Although there was at the time work being done to increase the ability of our infrastructure, for example the Toome Bypass, not enough work was done on rural infrastructure to substantiate such an increase in distance. Another major issue with Developing Better Services and what we have now is that the Mid Ulster Hospital does not and will not have the services as defined as a local Hospital in Developing Better services (page 18)

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1. Mid Ulster hospital to have its statues of 9am to 11pm A&E restored, with ambulance bypass protocols from 2006 brought into effectiveness. 2. Minor Injury status to be introduced from the hours of 11pm to 9am, a bypass protocol will need to be developed with the NHSCT and NIAS. 3. Doctor on call based in Moneymore to provide backup cover for the A&E and Minor Injury Unit. 4. The High Dependency Unit to be bedded and re-staffed in order to receive , if any, patients admitted from A&E 5. The decision to remove the High Dependency Unit to be question by the Health Committee as the risk assessment in 2006 specifically states this unit to remain as part of the critical care network. 6. Ward 2 to be restored, this will alleviate bed pressures at other network hospitals & also provide beds for those admitted from A&E. 7. Ward 3 to be restored, the current plan to close Thompson house will leave a major bed shortage across the each Health Trust, Ward 3 to be reopened for these patients. Having these patients in Ward 3 will also combat the pressure on services such as NIAS to deliver patients for Xray scans. 8. Thompson house to gain several consultant based clinics that are ear marked to be placed in the main hospital building, with the consultants also being rotated as cover for the A&E and High Dependency Unit. 9. That Dr Maurice Hayes is made available for questioning by the Health Committee on Developing Better Services. 10. For every manager or director involved in the rundown of services to be prevented from taking part in any further review into health in Northern Ireland.

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Appendix 1
Deloitte review of minor injuries provision at the Mid Ulster and Whiteabbey Hospitals , April 2011

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Appendix 2 Ambulance Bypass protocols Mid Ulster

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Appendix 2.1 Freedom of Information Ambulance Response Times

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Appendix 3 Freedom Of Information pertaining to CSR 2008

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Appendix 3.1 EQIA on CSR2008

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Appendix 3.2 CSR 2008 Responses

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Appendix 4 Developing Better Services What is a local Hospital?

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Appendix 5 Historical List of reference to ensure that extra beds were available when removing the Mid Ulster Hospitals

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REFERENCES TO BEDS AND THE NEED FOR INCREASED BEDS AT ANTRIM AREA HOSPITAL: (all files are held electronically by SAVE THE MID) Acute Hospital Review Group Report, June 2001 Emergency care services should be phased out at Mid Ulster Hospital as soon as alternative arrangements are in place at Antrim Area Hospital We also believe that a withdrawal of emergency services from the Mid Ulster at present would generate additional demand for Antrim Area Hospital with which it has not currently the capacity to cope. ACUTE HOSPITALS REVIEW GROUP REPORT, SEPTEMBER 2001, RCGP SUMMARY PAPER 2001/10 The above measure should be undertaken with due caution because: Travelling times can be longer than an hour. - The Toome bypass should be completed if emergency services are to be withdrawn. Antrim area Hospital does not have the capacity to cope with the extra cases. COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY Evidence Given in Relation to the Response to the Department of Health, Social Services and Public Safety's Consultation Document, Developing Better Services - Modernising Hospitals Ordered by The Committee for Health, Social Services and Public Safety to be printed 9 October 2002 Report: E2/02 1.19 Implementation of the NHSSB proposal will result in a 28% reduction in both acute and total bed availability (300 and 288 beds respectively) in the Board area. This reduction assumes that the planned expansion at Antrim to provide 125 additional beds is completed. 2.14 This option would require additional capacity at Antrim hospital comprising additional theatres and an additional 130 beds. 2.20 Capacity - the transfer of acute services from the Mid Ulster Hospital and Whiteabbey Hospital will result in under capacity at Antrim Hospital, this raises the question where will patients go to access Acute Hospital Services. 5.1 in their strategy document "Towards a better future" the NHSSB concede that implementation of their proposals to transfer acute services from the Mid Ulster Hospital to Antrim would require "significant development at Antrim Hospital". However, there is widespread scepticism of this commitment within both the CDC and MDC areas given the failure to deliver the previously promised expansion at Antrim. 9 In any event, Antrim Area Hospital should be accorded priority for development in acknowledgement of the demonstrated existing pressure on capacity, and the inability to develop a strategic plan for the site pending final decisions on acute hospital provision.

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Implementing Developing Better Services, NHSSB, January 2004 1.12 the scale and nature of change will mean that implementation will have to be carefully planned and managed over a period of time. Initial priority will be placed on increasing the infrastructure and capacity of Antrim Area Hospital to cope with additional activity and in parallel investing in a more diverse range of community care services. 2.5 Antrim Area Hospital will be further developed as the main acute hospital for the Northern Board population. Its capacity and range of services will be expanded further, to include, for example, in-patient fracture and orthopaedic services. 2.8 early steps will be taken to implement these developments and changes. The scale and nature of change will mean these have to be carefully planned and managed over a period of time. Initial emphasis will be placed on increasing the infrastructure and capacity of Antrim Area Hospital to cope with additional activity and in parallel investing in a more diverse range of community care services. All Our Futures Investment Proposals for Community and Hospital Services, NHSSB 2005 These proposals translate into a significant 600m programme of change for hospital and community services across the Boards area including: approximately 200 additional beds at Antrim Area Hospital The first phase of Antrim Area Hospital comprised approximately 350 beds and was completed in 1994. DBS takes forward Phase 2 which will extend the hospital by more than 200 beds. Risk Assessment of Key Acute Services, Deloitte Touch prior to the, Implementation of Developing Better Services, 2006, was in connection with the shortening of A&E opening times at Mid Ulster 9am-11pm, Whiteabbey 9am-5pm and the removal of maternity from the Mid Ulster site This would require new developments in Antrim to provide an additional 200 acute beds, an orthopaedic unit, more renal dialysis units and an elderly care unit for orthogeriatrics, stroke patients and rehabilitation. (b) The new 24 bedded ward at Antrim Area Hospital be opened along with the proposed introduction of the schemes to reduce admission and length of stay. 2006/2007 Director of Public Healths Annual Report Business cases for expansion of acute services at Antrim Hospital and a major modernisation of primary and community facilities are being finalised. The next few years will see this work completed. NHSSB, consultation on a policy of improvement in health and social services to support the replacement of Braid Valley Hospital, Ballymena and Inver House, Larne with new high quality services and facilities in Ballymena and Larne. 21 September 2006 5.8 Two new wards are planned for Antrim hospital and will open in 2009

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SARI Annual Report 2007 The review came down in favour of a system which reduced the number of laboratories from 14 to 7. Specifically in Microbiology, there would be a 24 hour service in Belfast and in Derry and a 12 hour service would be provided in Antrim, Craigavon and Ulster Hospitals. (Must be noted that this is laboratory space, highlighted as the space needed for laboratory work will encroach on space available for beds) SERVICE PERFORMANCE REPORT, NHSSB, FEBRUARY 2007 Antrim Area Hospital. Recently the Department approved 1.8m Business Case to extend Antrims A&E Department. Northern Ireland Hospital Statistics 2002/2003 to 2007/2008 Key Points, DHSSPS Comparing 2007/2008 with 2002/2003 the average number of available beds decreased by 428.2 (5.2%) for all Programmes of Care. Northern Health and Social Care Trust, Annual Report 2008/09 Interventions to meet the pressures include the development of medical assessment service and plans to increase bed capacity at Antrim Area Hospital and expanding the physical space within Accident and Within the CSR period the Trust will take forward the changes to acute inpatient and A&E services at Whiteabbey Hospital. The full anticipated changes to acute inpatient and A&E services at Mid Ulster Hospital cannot be completed in advance of the new ward block at Antrim Area Hospital. In the interim period significant effort will be made to retain and support acute inpatient and A&E services at Mid Ulster Hospital to ensure services can be sustained until the additional capacity at Antrim is in place subject to clinical risk and patient safety issues which may emerge. Stuart MacDonnell Chief Executive Northern Health and Social Services Board, File Ref: 67/333, 2 January 2008. Letter to OFMDFM, Economic Policy Unit Antrim hospital continues to operate within a fraction of its necessary capacity. Owing to a partial build in early 1990s it can no longer fully meet the demands of its increasing population base. As a consequence, it now urgently needs: o o o o o o o o 20 further renal stations; A fracture and orthopaedic unit; Additional elder care beds; New palliative care beds; A second CT scanner and other imaging services; An extended A&E department; An extended outpatient department; and 200 additional acute care inpatient beds.

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Reconfiguration of Acute Hospital Services, NHSCT, Jan 2009 The need to make these changes in the interest of safe and sustainable services means that the proposals could be phased from an early date in the current year, commencing first with the changes taking effect at Whiteabbey Hospital. By doing this we would reduce the risks associated with delivery of acute inpatient and Accident & Emergency Services in the Trust area, strengthening the medical staff rotas. The next phase of change would require further additional bed capacity at Antrim Hospital and would be phased based on the ability to create that extra space and on the presenting safety issues that would remain, covering medical rotas and securing appropriate medical cover.(page 2) It is proposed to review and potentially reconfigure inpatient services at Whiteabbey and Mid Ulster Hospitals through re-provision and increased capacity planned at Antrim Hospital and Belfast hospitals. (Page 9) A new ward block planned for Antrim will ensure extra capacity and avoid any reduction of in-patient services overall. However this new ward block will not be available for some time and it is proposed to make changes in a phased way from an early date in the current year, commencing with acute in-patient and Accident & Emergency services at Whiteabbey Hospital. (Page 10) In order to develop additional capacity at Antrim Hospital, the Trust will submit a business case to the DHSSPS for a minimum of 48 acute beds and 12 bedded palliative care unit at Antrim Hospital. This development depends on capital and revenue investment. (Page 11) Acute Hospital Services Reform, Information for Trust Staff, February 2009, pages 1 & 2 However, there is a need to increase capacity at Antrim Area Hospital before these changes can be implemented. A temporary ward is planned at Antrim to facilitate the changes from Whiteabbey (expected about Jan 2010) and a new permanent ward block (likely to take 2 to 3 years to complete) will create the capacity at Antrim Area Hospital to enable changes at Mid Ulster Hospital. Northern Health and Social Services Corporate Plan, 2009-20012 There is also the need to increase physical capacity within A&E and acute hospitals beds. We must ensure our 2 acute hospitals optimise the space available for acute work and develop our capacity for nonacute services beyond those boundaries. Additional capacity will be required at Antrim to support the reform of acute services in the smaller hospitals in the Trust and the Minister has committed 175 million capital investment across the Trust area over the next decade. This includes a commitment to a new ward block at Antrim Area Hospital and to 5 Health and Care Centres (HCC) across the Trust. Principle objective to have A&E in Antrim extended for year 09/10 Ms Norma Evans (Northern Health and Social Care Trust) COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY, Efficiency Savings, 12 February 2009. The changes at both hospitals are dependent on a new ward block being built at Antrim Area Hospital, which currently has just over 400 beds. It was originally intended that that hospital would have over 600 beds. It was to be a phased development, but only phase 1 was ever completed Our principal difficulty, however, is that because the second phase of Antrim Area Hospital has not been delivered, there are not enough beds there to move on Whiteabbey Hospital and the Mid-Ulster Hospital without the new ward block

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NHSCT, CSR Reform and Modernisation Proposals, Consultation Findings, Consideration and Decisions. 26 March 2009 The Trust recognise that the full reconfiguration of acute services and A&E at Mid Ulster Hospital, Magherafelt and Whiteabbey at the same time is not possible within the CSR Period and will require additional capacity in Antrim and Causeway which is dependent on a new build ward block at Antrim. OUTLINE BUSINESS CASE FOR THE DEVELOPMENT OF A&E SERVICES AT ANTRIM AREA HOSPITAL Executive Summary, August 2009 As a result, roughly 12,000 (23%) additional attendances were seen on the Antrim site in 2008/09. The floor space in Antrim Area Hospital has not increased correspondingly. The shortage of space in the Antrim Area Hospital A&E Department has an adverse effect on: Patients and relatives experience of visiting the Antrim Area A&E Department. Due to insufficient number of cubicles, patients stay in public areas when they should be in clinical areas. This has implication for control of infection. There is insufficient space for relatives, particularly if the patient is a child or a vulnerable adult. Northern Health and Social Care Trust, Minutes of the Twenty-Ninth meeting of Trust Board held at 2.00pm on Thursday 22 October 2009 in Fern House, Antrim Area Hospital. Members noted that the proposal to expand the services at Antrim was necessary due to: the increased attendances at Antrim Area Hospital based on projected attendances of over 77,000; Committee for Health Social Services and Public Safety, Evidence Session on Comprehensive Spending Review Efficiencies with the Northern Health and Social Care Trust 5 November 2009 The Committee will also be aware of the trusts reform programme for its acute hospital services. The trust is in the process of implementing the changes for the Whiteabbey Hospital and the Mid-Ulster Hospital, and the first phase of those changes is currently under way. The second phase will take place when we are a position, at the Antrim Area Hospital, to ensure that the necessary enabling works have been carried out. We must also be sure that the necessary resources have been invested to enable us to cope with the rationalisation of the A&E and inpatient medical services at the Mid-Ulster and Whiteabbey Hospitals. We are making good progress in both areas. Colm Donaghy. The overall birth rate has gone up by 11%, and at Antrim Area Hospital by 36%, but that increase takes into account the transfer of maternity services to there from the Mid-Ulster Hospital. Colm Donaghy COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY, Evidence Session with Departmental Officials on Acute Services in Northern Ireland, 27 May 2010 The business case for the new build and its additional 24 beds is with the Department. The decision brought with it other increases in capacity at Antrim, in the A&E department and additional beds throughout the hospital David Galloway DHSSPS Corporate Plan 2010/11 2012/13, 16 June 2010, NHSCT A number of significant development projects will be taken forward over the next 3 years, including: o Additional ward capacity in Antrim Area Hospital for 24 beds to be located above a new A&E Department. This is to be completed by September 2012 at a cost of 5.1m o A new build ground floor extension for the Antrim Area Hospital Accident & Emergency Department, adjacent to the current X-ray Department, to be completed by September 2012 at a cost of 9.2m to meet current building / space standards and facilitate the increased demand as a result of the change in service models to Minor Injuries Units at Whiteabbey Hospital and Mid-Ulster Hospital.
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Appendix 6 Mid Ulster Health Facts

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