Doctors say Chorley A&E reopening next week is "misguided and dangerous"

The unit is due to reopen on Monday (2nd November), between 8am and 5pm, having been closed for seven months because of the coronavirus crisis.

However, 17 emergency department consultants have now written to the clinical director of Lancashire Teaching Hospitals NHS Foundation Trust (LTH) to say they feel hospital bosses have been “subjected to an undercurrent of external pressure which has resulted in an unsafe decision being taken to re-open the [A&E] prematurely”.

The area’s three MPs were vocal in their opposition to the temporary closure of the facility in the spring – and have since lobbied hard for its reopening.

During the summer, health secretary Matt Hancock made two asides in Parliament over the issue to Commons Speaker and Chorley MP Sir Lindsay Hoyle – saying on one occasion that he was “a huge enthusiast” for Chorley A&E.

In response to the explosive letter – in which the medics also warn that the move is “misguided and dangerous” – LTH said that the reopening will go ahead as planned “unless further risks are identified”.

A previous plan to bring the facility back into operation late last month was postponed because not enough senior staff had been recruited to cover newly-created Covid and non-Covid zones. The trust has since said it will use locums to plug any remaining gaps in the rota.

When embryonic reopening plans were first mooted in July, the trust also made it clear that they could be derailed if Covid cases “begin to rise significantly”.

Figures emerged last week that there were 114 coronavirus patients then being treated at LTH - lower than at the peak of the first wave, but a marked increase in a matter of weeks.

The consultants’ letter, published by the Health Service Journal and dated 26th October, alights on both the virus and staffing as major concerns.

“The timing is almost as poor as it could be – Lancashire is in the midst of a surge of Covid-19 cases, filling both inpatient and critical care beds.

“A number of the doctors who will be expected to function as the most senior person on site at Chorley…are taking up their first role in the UK. An appropriate timescale for reopening would allow them to have a period of supported experience at the Royal Preston Hospital before stepping up to staff Chorley.”

LTH medical director Dr. Gerry Skailes told a trust board meeting earlier this month that five out of the seven “senior decision makers” who had been recruited at that time would be arriving from abroad.

She said that “some will be able to hit the ground running and others will take more time".

“We will ensure that they have a proper induction programme and will be monitored and not be put in a position where they’re needing to lead a shift until they’re able to do so,” Dr. Skailes said.

A total of 12 senior-decision makers – 10 middle-grade doctors and two consultants - are required for Chorley A&E to re-open. It is not known if any of the five posts which remained vacant at the start of the month have been filled or if all will have to be covered by locums, but the Local Democtracy Reportign Service understands that recruitment efforts have been continuing in recent weeks.

The concerned consultants added in their letter that infection control policies and the numbers of staff unable to work with Covid patients for health reasons had restricted the ability to “flex staffing to cover sickness and mandatory isolation periods”

They continue: “To expect the same limited senior team to expand to cover a further two clinical areas at Chorley as winter influenza season starts is misguided and dangerous.

“We recognise the decision is a fait accompli and we therefore have no option but to re-rota our already stretched consultant workforce and attempt to mitigate the lack of safety at Chorley as much as is in our control.”

A spokesperson for LTH said: “In September, our board took a decision that we were not in a position to sufficiently mitigate the risks associated with re-opening of Chorley emergency department (ED) on a 12-hour basis. This was mainly due to the lack of senior decision makers to safely run a second Covid-secure ED.

“However, following a further and thorough clinically-led assurance process involving regulators, board subsequently took the decision that we are in a position to mitigate the risks of offering a reduced hours adult-only ED service from 2nd November.

“The circumstances our teams are working in are unprecedented, and we take very seriously the concerns these consultants have about taking on this extra workload given the rapidly rising numbers of Covid cases.

“However, we need to balance these concerns with our responsibility to offer an accessible service to local people, wherever possible.

“We will continue to engage with our clinical teams about their concerns. The situation will be reviewed on a very regular basis both at trust and a system level. Unless further risks are identified, the ED will re-open as planned on Monday.”

Sir Lindsay Hoyle said he was pleased that the unit was reopening and added: “NHS England have said it’s safe to reopen - it’s not me who takes this decision.”

South Ribble MP Katherine Fletcher said she attended a recent meeting with NHS England about the plans.

“I am not clinically qualified, but as a lay observer, I am surprised they would recommend action if it wasn’t compatible with good clinical practice.”

Ribble Valley MP Nigel Evans said the repoening was “long overdue”.

“What’s unsafe is people having to travel way out of their way unnecessarily in order to access the A&E [service] they have been used to getting until it was summarily closed. Delay isn’t just inconvenient – we are talking about emergencies,” Mr. Evans added.

A £970,000 overhaul of the layout of the department has been carried out to create ‘red and green zones’ for Covid and non-Covid patients.

As the Local Democracy Reporting Service revealed last month, NHS England ordered that the unit must reopen before a long-delayed consultation into its long-term future – and possible closure – could begin.

Commenting on the consultants’ letter Denis Gizzi, chief officer at Central Lancashire’s clinical commission groups (CCGs), said:

“We are aware of the concerns raised…and are confident that the trust will now urgently liaise with the consultants to understand the clinical safety concerns that they have raised.

“We are also in regular dialogue with the trust so that we can continue to be assured that the risks associated with re-opening the Chorley ED service on 2nd November can be effectively managed.”

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