Andy Burnham MP
Secretary of State for Health
Richmond House
79 Whitehall
London SW1A 2NS

12 November 2009

Dear Andy,

Thank you so much for the meeting on Monday which allowed me to put the case for re-instating the Accident and Emergency Department at Burnley General linked to an agreed protocol, publicly available, explaining what the A&E could and could not do.

Burnley’s Urgent Care Centre already offers more than the name suggests. It is not a “nurse led” UCC but has a consultant in emergency medicine heading the unit from 9am to 5pm. And there is a Senior Registrar and other medical staff working there around the clock, seven days a week. The number of patients being treated today at the UCC is well below the number projected when the changes were introduced. In 2007, the planning assumption was that the UCC would see 85% of the people who turned up at Burnley when it had a fully functioning A&E. In fact, the figure is now 64%.

Burnley General does not deal solely with planned admissions. The UCC and the adjoining specialist unit are already dealing with the majority of emergency paediatric and obstetrics and gynaecology admissions. In addition, the ophthalmology department treats all emergency and planned admission patients. This fact alone would fit your department’s definition of a Type 2 A&E department.

I was very disappointed that you were unable to agree to an independent clinical review, especially since I said I would be bound by its decision. Instead, you offered an internal NHS review of Burnley UCC, to be carried out by the Strategic Health Authority. It would be helpful to know its scope and terms of reference, when it is likely to report and to whom. And will it, as part of the remit, look at the “two A&Es” model at Preston and Chorley and at Halifax and Huddersfield? If it does not, many people will conclude it is not worth the candle.
In the course of our meeting you referred to improved mortality figures at Blackburn and these are indeed welcome. This can be put down to the improved cardiac unit performance following reconfiguration. But I take the view that a fully functioning A&E at Burnley would mean further improvements in mortality rates.

We talked about the Alberti review and the report of the Lancashire Overview and Scrutiny Committee. The former, obtained only after a FoI request, raised very serious concerns about process and the implementation of the reconfiguration. Professor Alberti, the architect of the changes, said in his report to the National Clinical Advisory Team that the “reinstatement of emergency care services at Burnley is not feasible… In particular, the volume of patients would not justify the employment of the specialist clinicians required to sustain an emergency service and such a service would be unsafe and detrimental to meeting the needs of patients”.

In fact, your own figures show there are around 60 A&E departments in England which today have a smaller throughput of patients than Burnley in 2003 when it had its own A&E (and when separate figures for Burnley were last collected).

As you know, the Overview and Scrutiny Committee called on the NHS to “publicly prove that the reconfiguration is giving better outcomes for patients…” It went on: “If this cannot be proven then the case must be made why a fully functioning round the clock Emergency Department cannot be provided at Burnley General Hospital as well as the Royal Blackburn”.

The fact is, that two years after the change, with huge upheavals in senior hospital management, changes to the Board, and continuing controversy, the East Lancashire Hospitals NHS Trust has not been able convincingly to demonstrate these better outcomes. The brutal fact is that Blackburn has not met the 4 hour maximum wait target at any time since the reconfiguration in November 2007.

This explains why the vast majority of the public and all the political parties in Pendle and Burnley remain determined to see the reinstatement of A&E at Burnley.

Yours sincerely

GORDON PRENTICE MP