When the old cottage hospital in Chipping Norton closed its emergency department several years ago, health officials said there was no need for an A&E in the area. The locals disagreed and made their feelings known. During discussions about how to quell a Cotswolds revolt, one forward-thinking representative had a bright idea. Once the staff at the new Chipping Norton War Memorial Community Hospital outpatient unit went home, another body of experts could come in and use of the otherwise empty building.
Since April 2011, it has been home to South Central Ambulance Service’s First Aid Unit – a group of specialist paramedics who serve the community during evenings, weekends and bank holidays.
“In the first month we saw 40 patients,” says Gary Toohey, 58, who has been at the unit since its inception, when it was given a six month trial. “We’re now seeing over 200 a month – and that’s largely through word of mouth. People hear ‘first aid’ and automatically think ‘cuts and bruises’, but everything walks through that door. We’ve even delivered three babies here in the last 18 months.
“It feels weird to say, in the centre of the south of England, that we’re ‘remote’, but when you look at the nearest hospital is Banbury, a 25 minute drive away, we are remote. People will knock on the door for any woe they have, be it minor or major illness, minor or major injury.”
The unit reduces volume of people and queues in A&Es, such as the closest emergency department at Banbury Hospital. It relieves pressure on A&E staff and keeps more of the ambulance services’ staff and vehicles available for use – vital given that there are between 120 and 140 ambulances on the road at any one time in this SCAS patch of four million people. That equates to one ambulance for every 20,000 people during the day time, and one for every 35,000 people at night. It also helps take some of the load off GPs.
The first aid unit costs Oxfordshire Clinical Commissioning Group around £90,000 a year to run, which covers salaries and medical equipment. No one has worked out quite how much money is being saved but given the cost of sending an ambulance to a patient is around £300, and the cost of a patient attending the unit is significantly less than that, it will be substantial.
A&E waiting times worsening around the country
SCAS believe it is the only unit of its kind in the country, run entirely by specialist paramedics, and could be easily replicated as a model of future unscheduled, urgent care for rural communities across the country. Emergency services need all the help they can get. Latest official statistics, published last month, revealed that this summer’s A&E waiting times were worse than almost every winter since 2004. One in 10 patients were forced to wait more than four hours in June, July and August, with admissions in the final month up almost 5 per cent on the same period last year.
Dr Mark Holland, President of the Society for Acute Medicine, said the NHS was now “on its knees” and parts “will implode” this winter, traditionally the most challenging time of year for hospitals.
The out of hours service is also changing. Starting in December, NHS 111 will refer fewer patients to GP out-of-hours services and A&E after the Department of Health said GPs were spending nearly 40 per cent of their time advising patients on minor ailments. Patients requiring urgent repeat prescriptions, or suffering minor issues like ear aches, sore throats or bites, will be sent straight to a community pharmacy instead, who themselves have just had more than £300m cut from their budgets over the next two years.
At a time of constant headlines of the dire situation NHS finances are in, it is odd why Chipping Norton’s First Aid Unit is not being promoted as a best practice model and someone from either the Department of Health or NHS England is grabbing Gary for a national roadshow telling other CCGs what they should be doing.
“All the staff who work here love it, because it’s so different and really keeps you on your toes with your skills because you never know what’s coming through the door,” says Gary, adding that the contrast to life on the road is stark. “We get abuse every day. It’s just a strange contrast. When people have to present themselves here, they are different.”
The majority of Oxfordshire’s specialist paramedics – critical care practitioners who have higher skills in managing patients with minor injury, minor illness and primary care needs – rotate here at the unit. In charge during i’s visit on an October Sunday is Georgette Eaton, 26, who is also a lecturer in Paramedic Science at Oxford Brookes University.
First through the doors is tree surgeon Ben Southall, who has brought his 18-month-old daughter Bella to check a rash. Georgette reassures Ben that the rash his daughter has is “a good rash,” if a toddler is to have one at all, and not the meningitis that he feared.
“My wife had meningitis when she was younger, so as soon as you see a rash you start to get a bit panicky,” says Ben. “It’s a two minute drive here, otherwise it would have been a 25 minute trek to Banbury and how long to wait?”
Ben himself has had cause to come here, unsurprising given the nature his job. The 34-year-old has been cutting trees for 16 years and lost four fellow tree surgeons he knows to fatal accidents during that time. It is one of the most dangerous jobs in the country.
“You can suffer catastrophic bleeds in my line of work, it’s highly dangerous,” he says. “The response time without this unit would be quite slow. That might be the difference in saving one of us one day. In a rural community, it’s pretty paramount we’ve got the health cover we need. There are lots of blokes like me, working seven days a week, not necessarily doing the safest of jobs.”
Joanne Forde arrives with her 10-week-old baby, Sonny, who has a case of oral thrush, a fungal infection in the mouth that’s usually harmless and easily treatable. They are seen instantly.
“This unit is hugely important. If I had to wait until tomorrow morning I would have had to come in the morning [to the GP surgery] to the walk in centre and who knows how long we would have to wait,” Joanne says, who was directed here by the pharmacist. “I’d have had to bring my two-year-old daughter as well. But I can come here and get it sorted. I wish I’d realised earlier it was here! I’ll tell everyone else now.”
After a morning lull, the patients are coming thick and fast. Georgette tells eight-year-old Flo Smith to “bazooka that veruca” on her foot while 73-year-old Robert Wastie, who has just moved back to Chipping Norton after living in east Yorkshire for the last 28 years, waits for his hand to be seen.
“I had an ‘outside accident’,” he says. “Trapped it and then as I was pulling it away scraped the skin off. I tried to patch myself up but not sure how good a job I’ve done.”
Skin tears are common for people of Robert’s age, Georgette tells him as she tends the wound. “That looks much better,” Robert says as he’s about to leave. “I’m most impressed with all of this.”
From minor ailments to serious conditions
A poster in the waiting room reminds the public how they should treat A&E. “For less severe symptoms, know your choices,” it says, above six people with various ailments, adding: “Only one of these people need A&E.”
An arrow points to the man with “severe chest pains” as the candidate. The others – suffering from bad earache, a cut finger, the flu, someone wanting the morning after pill and a pained looking rugby player clutching a bag of peas – should leave the emergency department alone. But the trouble is for many people, where do they go at night or the weekends?
Although the day’s patients have not had serious conditions, however in several cases the individuals or parents do not know that until they come in, those that do require urgent treatment at hospital will be dispatched to A&E. “We send for Big Brother”, as Gary puts it. The specialist paramedics can get called out – if they are not dealing with patients – and only then do they tend to be ‘red’ calls, where there is an immediate life threat, such as a serious road traffic accident or cardiac arrest.
Construction worker Richard Abbotts, 34, arrives with pen marks dotted around his swollen arm, marks that had been made by Georgette on his previous visit so she could see whether the swelling caused by his cellulitis was getting worse or not. It looks alarming. Cellulitis is an infection of the deeper layers of skin and the underlying tissue, which can be serious if not treated promptly.
“I didn’t know if I should go to hospital or not, so I came back in here. It’s great to have somewhere out of hours like this,” Richard says, having been reassured the condition is not worsening.
The thank you cards lining the walls are testament to how the locals feel about the specialist paramedics. Gary and Georgette often see around 20 patients a day – four times the number they would see out on the road.
“That’s clerking, doing all the paperwork, treating, discharge or pathway to somewhere else,” Gary says. “No paramedic [on the road] would see anything like that number.”
He has also found a new appreciation of the famous Cotswold craftsmen. “Stonewallers, thatchers – when they come in, you know it’s bad. I had a chap come in, at the wife’s insistence, who had cut through his little finger in the morning. His wife had caught him at the tea table at 6 in the evening with her sewing kit trying to sew his finger back together.
“He ended up in surgery as he had cut through the bone – didn’t stop him working all day long. That’s the kind of mentality you get. They are as hard as a bag of nails.”
Friends that Georgette studied with, dotted around the country, often tell her their patches should have the same system.
“It does make sense. I think there should be more,” she says. “It fills a gap in the community and we have a really good relationship with our GPs in the area. We do cover a gap in the out of hours service in this region, which is really important for patient care and satisfaction.”
“You know you’re doing all right when one of the local GPs comes in here to be seen,” Gary chuckles. “It might have been a reccy on their part, but they were genuinely injured and went away happy.”
If there is only one gripe, it is that the funding review for the unit comes around every year, leading to the inevitable ‘will they, won’t they’ questions by the specialist paramedics. A five year funding plan, for example, would mean greater stability for what Gary calls “Chipping Norton’s little secret”.
“Some of the locals don’t even know we’re here. Though I suppose that might all change now,” he laughs.