The decision to reduce the hours of the MIU will be considered by the new Health Scrutiny Committee of Herefordshire Council in December and members of the panel and public who met at the Larruperz Centre to discuss the reduction in hours vowed to keep fighting for them to be reinstated.

More than 100 concerned Ross residents turned up to the Larruperz Centre on Tuesday, October 30th, to listen to representatives of the Wye Valley Trust explain their reasons for reducing the opening hours at the MIU.

The unit was open 24 hours a day, seven days a week, until Monday, October 1st when a shock announcement was made by Dr Peter Wilson of the Trust. He said that the decision had been made to protect the clinical safety of patients attending the MIU, and those in wards at the community hospital, and to protect the safety of staff who often have to treat patients alone at night.

Dr Wilson was invited to attend the public meeting and he was part of a panel of speakers which also included Barbara Barter, League of Friends, Dr Clayton, Alton Street Surgery, Paul Deneen, former chairman of a Hospital Committee and Dr Vicky Alner, Service Director Wye Valley Trust.

The meeting was arranged and chaired by the Mayor of Ross Councillor David Ravenscroft on behalf of the Town Council.

Dr Wilson reiterated the reasons for the reduction in hours. He said that patient safety is his prime concern and he is committed to the right care not looking to reduce services.

He talked about the highly qualified MIU staff and gave average numbers of people attending the MIU. These figures were disputed by members of the audience and Dr Clayton, a member of the panel.

Dr Wilson explained that patient safety was an issue when patients attended MIU for services which the staff were not qualified for or at night when staff had to leave wards. He has been a Doctor for 30 years and he said that patient safety is his prime concern. He referred to increases in service provided at the Community Hospital and said the Trust was not looking to reduce services.

Dr Wilson said that in the four weeks since the reduction in hours there had been no change in the numbers attending other services, such as A&E and there was a huge variety of cover nationally, most of which are not open 24/7.

Dr Wilson added that the decision which was made on Thursday, Sept 27th was not made lightly but it was felt by the Trust that they could not put people at further risk. That was why there was only four days between the decision being made and the reduction in the Unit's hours. He reassured the audience that it was not a forerunner to hospital closures, it was a clinical not financial decision.

Barbara Barter, said that the way the situation had been handled was, "no way to treat people,' She added that in the whole of the time she had been involved in th friends she was not aware of any safety issues.

She said that she believes the A&E is already overstretched and the MIU should be open at least 8am - 8pm, seven days a week. A petition organised by the Friends has over 2000 signatures which shows the strength of local feeling.

Dr Clayton added that he had respect for Dr Wilson and Dr Alner's clinical expertise but was angry at the way they had managed this situation.

He said that many services in Ross were being lost and now people have to travel to Hereford and pay extortionate parking fees. He said we have lost the MIU for 75% of the time and the 25% it is open is when the GP practice is open. "I'm just seeing cuts," he said. He asked how many GPs were involved in the decision.

He said that he had spoken to someone who said that the whole area of MIUs?was being looked at about a month before decision was taken and he asked why they did not have time in that month to come down and have a chat, he asked if other services were warned.

He spoke about cases where he had to deal with people coming to him at MIU when they really needed to be seen by A&E but he said we cannot call an ambulance then make them wait outside, we do what we can to stabilise them, this will be more dangerous in future and is insulting the highly trained MIU staff to say they cannot carry out duties without a GP.

The needle exchange service at weekends will end, people with blood clot treatment will have to call on District Nurses who are already over stretched. He said that he did not believe it was a training issue not a closure issue, everyone needs constant training and if it could take four days to close it why not four days to reopen it.

Paul Deneen expressed his shock that there were no options available. He said:?"What can we do to retain and improve service, training could be looked at but you have given us no options. Team Ross-on-Wye passionately wants to keep the MIU as lots of us had to fight tooth and nail for this service."

Questions from the audience revolved around it being a matter of financial cuts but this was denied by Dr Wilson and Dr Alner. She said the decision was made on safety grounds but Cllr Phil Cutter said:?"Don't insult our intelligence."

Cllr Atkinson said it is a subject everyone feels very emotional about. He said there has been no apology and "nothing you have said has made sense", you are treating the people of Ross like mushrooms." He added that if people could understand the decision, they might not like it but they could accept it.

Cllr Robert added her support for a return to 24 hour a day cover which had been in place since 1879.

One of the town's Community Paramedics made the point that as they cannot properly dress wounds at the side of the road if someone suffers a minor injury at weekends or evenings they used to take patient to the MIU, not this is not an option and they have to call an ambulance to take the patient to Hereford.

He disputed whether the closure was due to safety issues. He said staff are dealing with minor injuries, "it is like sacking me if I cannot carry out brain surgery, I am not trained or specialised and have to pass it on."

Brian Harris of Ross Rugby Club said that Sports Clubs in Ross had always made good use of the MIU. He said:?"We have our own first aiders but need the back up of the MIU at the hospital.A Ross GP in the audience, Dr Lenanne asked if there had been an incident which may cast light on the issue.

Dr Wilson refused to be drawn on this and concluded that the whole county needed to consider the provision of all emergency services and not get sidetracked by one issue.

Many of those attending the meeting were left with the impression that the decision had been taken for a reason which was not fully explained. One person claimed that the reduction in hours actually increased the risk to local residents with minor injuries.

After the meeting the Ross Gazette asked Dr Wilson several questions about the safety aspects but his reply covered similar ground as at the meeting. (The questions and answers are included in full below.)

Mr Paul Deneen who chaired the original campaign for the Community Hospital for Ross, and was asked to assist in relation to the Minor Injuries Unit issue said after the meeting:

"Firstly I would like to take the opportunity of thanking the Mayor David Ravenscroft for arranging the meeting and for chairing it so well. It was excellent to see the huge support from the community and from the local doctors, the League of Friends, County Councillors, Town Councillors and Ross Rural Parish Councillors.

"The outcome of the meeting was for myself and one of the local GPs to progress matters and to request the reinstatement of the full Minor Injuries Unit (MIU) service as soon as possible."

In the meantime The Gazette have requested and received a copy of the Report on the MIU which went before the Wye Valley Trust Board and having received it this morning I have circulated it to the Ross Gazette, to local GPs, the League of Friends and to the Town Council and for them to circulate it on to all local County, Town and Ross Rural Parish Councillors.

I have also written to the Wye Valley Trust and have invited the recently appointed Chief Executive Derek Smith to meet at the Ross-on-Wye Community Hospital with local GP's as soon as possible in order to discuss the whole matter of the MIU and the contents of the Wye Valley Trust Board report received on the Ross Community Hospital MIU and to express the views and strong feelings of local people on this very important issue."

The questions the Ross Gazette asked are as follows:

1 - As Dr Wilson insisted that the reduction of hours at the MIU was not on financial grounds but a safety issue can he give a fuller explanation of what the safety risk was? Was it a matter of patient safety in the wards, staff safety or the safety of patients visiting the MIU?

2 - As the decision to reduce the opening hours at the MI was made at a meeting without any prior consultation had there been a safety review which any of the staff would have been aware of or had a specific incident sparked the decision? If so was there also a similar incident in Leominster to account for the reduction in hours of that MIU as well?

3 - Does he not agree that the safety aspect could have been resolved by re-education of the public into what a MIU deals with or re-training for the staff, was there an incident so severe that it necessitated 75% closure of the whole service?

4 - Is there any possibility, after seeing the strength of local feeling, and knowing that there are over 2000 signatures on a petition calling for the decision to be rescinded, that the MIU will reopen, even if the hours are reduced?

The response from Dr Wilson was a statement as follows;

"Wye Valley NHS Trust welcomed the opportunity it had to listen to local people regarding the change to opening hours at Ross-on-Wye Minor Injury at last week's public meeting. The meeting was managed well and the Trust thanks Cllr David Ravenscoft for the way he steered the debate. It was an opportunity for the Trust to explain the rationale for the decision and to reinforce the fact that the decision was not made on financial grounds.

"The decision, made by the Trust Board at the end of September, was made on medical and clinical safety grounds: Staff at the MIU were increasingly being expected to carry out treatments they were not qualified to give, the number of staff on the ward at the town's community hospital was left unacceptably low when staff had to leave to attend patients in the MIU, and staff were often vulnerable when treating people alone or in pairs at night.

"These issues, which came about following a review of the service, affect the Minor Injury Units in Ross-on-Wye and Leominster, so the decision to change opening hours covers both units.

"A key element in taking forward the issue of minor injury out of hours provision in Herefordshire is ensuring people know what treatments MIUs can and cannot provide," said Dr Peter Wilson, the Trust's Medical Director.

"Over time, the expectations of MIUs have blurred which resulted in us having to make this decision quickly. It would have been wrong to allow the situation to continue – hence the speedy decision."

"He reiterated the kind of injuries which Minor Injury Units can treat. These include: Sprains and strains, broken bones without damage to the skin, wound infections, minor burns and scalds, minor head injuries, insect and animal bites, minor eye injuries and injuries to the back, shoulder and chest.

"At the meeting he also stated that there had been no impact on the number of people attending the Accident and Emergency Department at the County Hospital in Hereford over night and on weekends.

"We're now in a position to look closely at the attendance figures to ascertain what an efficient out of hours minor injury service for the county could look like, and we're working with those who commission the service in the county for a way forward.

"What's important now is that people realise the kind of injuries an MIU treats, and that if they have anything more serious, that they either visit A & E at the County Hospital in Hereford, or dial 999.

"There are, off course, a number of alternatives for those with a minor ailment – for example, sometimes a phone call to NHS Direct, a trip to a local pharmacy or your local GP might suffice," added Peter.

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