Grantham Hospital ‘does not meet criteria’ for critical care unit, leading doctor confirms

Grantham Hospital does not meet the criteria for a critical care unit, a leading doctor employed by the trust which runs Lincolnshire’s hospitals has said.

Dr Adam Wolverson, clinical director in theatres anaesthesia and critical care medicine at both Lincoln County and Grantham Hospital spoke to Lincolnshire Reporter in response to fears that changes to critical care would signify a downgrading of the A&E by the back door.

He confirmed that the only change in service provision since August was the overnight closure of Grantham A&E.

Critical care units, which look after patients with life-threatening conditions, have to be classed as either level 2 or level 3 under standardised NHS England requirements brought in a few years ago to ensure consistency across hospitals in the UK.

New NHS descriptions, replacing familiar terms such as high dependency or intensive care units, meant that Grantham fell into the criteria for a level 1 unit.

Level 1 units look after patients who would normally be under the care of surgeons and physicians but need more intensive monitoring.

This means that the more urgent cases are taken directly to the level 3 critical care unit in Lincoln or rushed to the Queen’s Medical Centre in Nottingham, rather than being taken to Grantham A&E and then transferred.

Dr Wolverson said: “For most patients, Grantham provides all the care they need very well. But for a small number of patients, smaller hospitals just become a middle man – they can’t give all the care that a patient needs.

“We’re trying to get patients straight to the care that they need. If the care you need is Grantham, then you go to Grantham. If the care you need is Nottingham or Lincoln, you go to Nottingham or to Lincoln.

“To compare what Grantham does with the new service specifications, Grantham does not meet the criteria for a critical care unit. It has to be a level 2 or level 3. Grantham is a level 1 unit.

“Following the new national specification, the name of the critical care unit at Grantham has been changed to an acute care unit to reflect the care it provides for patients.

“This does not change the quality or type of care given to the vast majority of patients or the expertise of staff who work there. Grantham hasn’t looked after level 3 patients for a number of years.

“The acute care unit is specifically a level 1 unit which provides more intensive and advanced care than in an ordinary ward but not the level you’d get at a critical care unit.

“It hasn’t been downgraded and if I’m honest there are lots of things required of a critical care unit that Grantham has never provided.”

Upgrade prospects

When asked by Lincolnshire Reporter if there were any prospects of an upgrade to the unit in Grantham, Dr Wolverson said that there are not enough consultants or patients to have a viable service.

He said: “To be absolutely honest with you, it would be very difficult. Patients in critical care units should be looked after by consultants who have had specialist training in critical care medicine.

“They have to be available 24 hours a day. They have to review all the patients at least twice a day. Those consultants have to be available within 30 minutes and can’t be on call for anything else.

“To run that sort of rota, you need eight critical care consultants. Grantham has none.

“Lincoln has got nine and Boston Pilgrim has got eight. We would like to have 10 in Lincoln but we can’t fill our last post and across the East Midlands there has been a real struggle to recruit critical care consultants.”

Dr Wolverson added that even if there were enough consultants, there were not enough patients requiring critical care in Grantham for the town to have a dedicated unit.

He said: “Even if magically we could find those critical care doctors and nurses, to get good outcomes for patients we know that critical care units need to treat a core number of patients.

“If you do it once a week, then you don’t achieve the best outcomes for patients. You could give Kwik Fit all the equipment a Formula 1 team has, but if they were only changing tyres once a week, they wouldn’t be like Ferrari or McLaren.

“The number of patients needed for critical care is around 350 to 450 a year. To put that into context, at the moment, patients who need care in Grantham get transferred to Lincoln.

“Last year they transferred 18 patients. So far this year, we’ve transferred nine.

“Even if you provided the service in Grantham, you wouldn’t be treating the number of patients you’d need to in order to provide a high-quality service.”