Peter Moore: Removing cardiac unit from Torbay flies in the face of fact

A few years ago an American hospital appeared to be performing miracles.

Their figures for the treatment of heart attacks were dramatically better than almost every other hospital. Being blunt, far less of their patients died. How were they able to perform miracles and how could the other hospitals improve their care to catch up? When the figures were analysed sadly there was no miracle.  The hospital was in the middle of nowhere, many miles from the nearest large town.  Ambulances were often taking over two hours to reach the hospital.

As many of the deaths from heart attacks occur in the first few hours patients were dying before reaching the heart unit. In any other hospital these people would have been admitted and count towards their statistics but here they died before getting to the unit and so were not included. When these patients were included in the statistics this hospital was a long way from performing a miracle.  

Over the last forty years improvements in medical care has meant that heart attacks need to be treated quickly.  This was not always true. When I was a new GP in the late 1970s we were encouraged to treat heart attacks at home. If someone had chest pain I would visit, take bloods, carry out an ECG and visit regularly over the next few days. At the time this was based on good evidence. The trauma of a hospital admission was often worse than staying at home

Today the guidance has completely changed as the treatment changed. Time is now crucial. Anyone ringing in with chest pain is advised to dial 999 for an emergency ambulance.  The message is even on the answerphone of every GP practice. The result? In the 1960s seven out of ten patients suffering from a heart attack died. Today seven out of ten survive. 

 Now heart attack patients might be given an injection to thin the blood, had an angiogram to locate the blockage and then a stent to open up any blocked artery. 

The suggestion from the Integrated Care Board (ICB) that the heart unit in Torbay Hospital is closed sending all patients to Exeter ignores every improvement over the last fifty years.  

Out of sixty-four cardiac units Torbay has the fourth best outcomes. This reflects excellent care helped by the fact that our cardiologists live nearby. The Exeter unit is already sending patients to Torbay when they are unable to cope.  

Closing any unit flies in the face of the Government’s ten-year plan to bring care closer to home but if a closure was needed why Torbay? With a population of 140,000 Torbay is the second largest conurbation in Devon and Cornwall with 23% over the age of sixty-five. The population is increased by holiday makers, many of whom are elderly.

When I was working as a GP I was often called out to see elderly holidaymakers with a heart problem. Torbay Hospital is also easily accessible from two dual carriageways while The Royal Devon and Exeter is further into the city. There are problems with ambulances, especially in the summer with the narrow Devon roads and so many of the patients admitted to Torbay go straight there. 

 Exeter has a median age of thirty-five, 12.400 students and only 17% over sixty-five. We do not need a health economist to work out where there is the greatest need. 

Whenever I research a column I try to listen to all the arguments but, despite my best efforts, I cannot find anyone to explain this proposal. Where is the public consultation or did I miss it? In the absence of hard information it is inevitable that conspiracy theories thrive. The one I keep hearing is that there is a problem with the structure of the buildings at Torbay Hospital and it is cheaper to close our unit than repair the building. 

I have aways been dubious about conspiracy theories and find it hard to believe that the NHS management would put the quality of the buildings above the welfare of the patients. The way to prevent conspiracy theories is for the ICB to explain the plan with all the supporting evidence. It is easy to sound like Sir Humphry Appleby in Yes Minister with vague words about “improvements”. 

There is an open meeting for the public at the Livermead House Hotel at 5pm on 29th July. Perhaps then they can explain to us all their reasoning. 

I am concerned that in ten years time the Exeter cardiac unit will follow the American example by publishing report into a miracle with impressive cardiac survival rates because Torbay patients who could have been saved died before reaching the unit.