One of my all time favourite stories is 'Around the world in eighty days'. I was envious of my hero Michael Palin when he choose to do it for real with the support of BBC. I hope to do my own around the world in 80days one day. For the moment due to time, financial and family constraints I am unable to do it. However I thought I shall write about my own little journey around my own world of emergency medicine and the circular motorway around Manchester.
There are 3 university hospitals and 10 district general hospitals in the greater Manchester area. Currently there is a review of all health care provisions in the greater Manchester under healthier together. A very ironic name which probably is going to threaten the very foundations of health care delivery in Manchester region and is probably going to be lethal to a quite a few hospitals and their future health.
Out of the 10 District Hospitals already 2 have been downgraded and only have an Urgent care centre. In the near future another 2 possibly 3 will go down the same path. Over the last 4 months I had the opportunity to work in the emergency departments of 6 of them apart from another 2 in the university hospitals. This is my own un-official review of the 8 'E' Departments.
1-MRI
University Hospital based in the centre of the city. Extremely busy, chaotic and urgently needs an expansion to increase the footprint so that staff can deliver the high quality care they provide in more suitable work environment. Academically and educationally brilliant place to work. They have opted to deal with the work force crisis at registrar level by creating their own internal rotation which has been successfully run over the last 6-7 years.
http://www.cmft.nhs.uk/royal-infirmary
2-Salford
University Hospital based in west of the city. Dubbed one of the best emergency departments in the country and recently named as the trust of the year in the whole of the NHS. Probably the best emergency department I have worked in and certainly the best in terms of work culture. Senior clinicians in all specialities and emergency medicine in particular are actually delivering clinical care and doing so in a healthy atmosphere. It is a University hospital with the friendly atmosphere of a DGH. Excellent place to work.
http://www.srft.nhs.uk/
3-Wigan
District General hospital in the western fringe of greater Manchester. Reasonable department with some positives. Probably one of the better run district general hospitals and certainly one of the cleanest. One of the emergency departments likely to survive the review of services because of their success in obtaining trauma receiving unit status. Currently discussions going on to work collaboratively with a neighbouring DGH. In future likely to take over the neighbour because of the dire financial and organisational status there.
http://www.wwl.nhs.uk/
4-Bolton
District General Hospital in the north western fringe of Greater Manchester. In spite of having the busiest emergency department and a good team of doctors and nurses likely to suffer adversely in the imminent cull of services. This is purely down to a poor work culture and dire financial and administrative situation over the last few years. Likely to be taken over by its relatively more successful neighbour.
http://www.boltonft.nhs.uk/
5-North Manchester
District General Hospital North-central part of the city. One of the emergency departments which are under threat in the review of services. Part of the problem is that it is one of four district general hospitals run by the same trust which is probably too big with a complex organisational problem and conflicting priorities. This department is currently plagued by a serious shortage of senior emergency clinicians and is too reliant on temporary staff.
http://www.pat.nhs.uk/Our-hospitals/Our-hospitals-North-Manchester.php
6-Oldham
District General Hospital in the north east of Greater Manchester. This department is currently being refurbished and expanded into a modern emergency department. Once completed it will not only be the flagship of this trust which runs four hospitals, but will probably become the model template for development in other hospitals in the region and possibly the country. It is a well run department with a healthy work atmosphere.
http://www.pat.nhs.uk/Our-hospitals/Our-hospitals-Royal-Oldham.php
7-Tameside
District General Hospital in the eastern edge of Greater Manchester. Unfortunately one of the hospitals which is frequently slated in the local and national press because it was one of 14 trusts which were reviewed by Keogh because of its high HSMR. I was pleasantly surprised by what I saw in this hospital. This is a trust which has listened and learnt from all the criticism it received. The emergency department is possibly one of the best I have worked in and has an excellent team of people working. All I can say is, this department and the trust will probably survive into the future simply because of this positive work culture.
http://www.tamesidehospital.nhs.uk/
8-Stockport
District General Hospital in the south of Greater Manchester. One of the busier emergency departments and possibly the most innovative and advanced in use of modern technology. This department and hospital probably has a secure future because of all the investments in the right direction.
http://www.stockport.nhs.uk/
That completes my journey around Eight-E Departments around the M60. Unfortunately I did not get a chance to work in one university hospital in the south of the city, two other DGH's and two Urgent care centres.
In summary there are good practises everywhere and some bad stuff in some places. Hospitals and emergency departments which are doing well appear to have a better 'work culture'. I wish senior decision makers take time to visit their neighbouring hospitals and departments to learn from each other. Our duty as an emergency physician is to deliver the best possible care to our patients and we will only achieve it if we are willing to take the extra effort to learn from each other. There will always be a lot of factors which are beyond our control which might determine the future of our departments. However to walk around moaning, whingeing and generally disillusioned with life as an emergency physician will get us nowhere. Good bye for now. Have a great 2014. I'll be back!
