Examination of Witnesses (Questions
105-119)
MS JULIE
MOORE AND
DR DAVID
ROSSER
21 JUNE 2007
Q105 Chairman: Welcome to the evidence
session here in Birmingham on the medical care that is given to
the Armed Forces of our country. Welcome to Julie Moore and Dr
Rosser. Thank you for showing us round Selly Oak this morning.
As we take evidence from you this afternoon I would ask you, please,
to remember that the microphone in front of you needs to be activated
when you speak. It would be helpful, probably in order to avoid
feedback and all that sort of stuff, if you could switch it off
when you stop speaking. Could I ask you, please, to introduce
yourselves and say what your role is. Julie Moore, would you like
to begin?
Ms Moore: My name is Julie Moore,
I am Chief Executive of University Hospital Birmingham which covers
the Queen Elizabeth and Selly Oak Hospitals.
Dr Rosser: Dave Rosser, I am currently
a consultant in intensive care at University Hospital but I am
also the Medical Director.
Q106 Chairman: Can I ask that people
switch your phones off otherwise it will cause all sorts of problems.
Can I begin with a rather important issue. Do you think the decision
to site the Royal Centre for Defence Medicine, the Centre for
Defence Medicine as it was then, at a large National Health Service
teaching hospital was the right one when it was taken? That is
a sort of yes or no question. Do you think it is the right way
for it to be run now?
Ms Moore: Thank you, Chairman.
Thank you for inviting us today to talk about this. I think it
was the right decision. Healthcare has evolved greatly now and
increasing sub-specialisation in medicine means you do need a
large acute teaching trust to have available all the specialties
required to treat what are pretty complex injuries. Some of the
soldiers we have had coming back from abroad have had upwards
of ten, 11, specialties working on them at one time and I think
only an acute teaching trust can provide that complex level of
care. How it is run at the moment, I think it is the right way
to do it, we are integrating military and NHS and both sides learn
from each other. I think we are providing an excellent standard
of care.
Q107 Chairman: Dr Rosser, do you
have anything to add?
Dr Rosser: I would just like to
emphasise the training role at the RCDM. One of the key functions
is not just about looking after the military patients when they
are evacuated to us, it is about making sure that staff who need
to go out to the frontline and provide clinical care in theatre
are adequately trained. As Julie says, if you are going to acquire
and keep those skills up-to-date you need a significant workload
and there is compelling evidence across a whole range of clinical
specialties that people who do more of the procedure get better
results. If you look at the workload, the complex surgery that
comes purely from the military, there simply is not enough work
to train and keep skilled a range of specialists.
Q108 Chairman: You have both given
very medically-based answers. We will come on to the military
ethos questions that all of this raises in a few minutes. Thank
you for those answers. Why Birmingham? What makes Birmingham the
right place, if it is the right place? Is it the right place?
Ms Moore: Birmingham is one of
seven major trauma centres throughout the country but in terms
of its central location, located near to a big airport and its
good road networks, I think that was one of the major factors
in choosing it so that patients can be easily transported when
they are aeromedically evacuated back to Birmingham. In addition,
it has got very strong partnerships with local universities, again
feeding the training environment at the Royal Centre for Defence
Medicine.
Q109 Chairman: By the way, you do
not have to add anything if you do not want to.
Dr Rosser: I was just weighing
up whether it adds value and I think it probably does. The other
thing is the range of clinical specialties we have is very extensive.
The only major specialties we do not provide are paediatrics and
obstetrics and gynaecology. If one is injured in any form of major
trauma any part of the body can be affected and we have surgical
specialists particularly skilled in dealing with virtually every
part of the body.
Q110 Chairman: Can you tell us, please,
how you are funded?
Ms Moore: We are funded on a very
similar basis to the NHS in that we get paid per patient that
we treat. In addition, there are some overhead costs put in to
support the aeromedical evacuation service based at the Trust.
Chairman: Moving on to the treatment
of casualties, David Crausby, the Vice-Chairman.
Q111 Mr Crausby: Thank you, Chairman.
Could you explain to us first of all, briefly, the patient pathway
for casualties from the frontline?
Dr Rosser: It depends on the severity
of the injury and the nature of the injury to an extent. Essentially
the evacuation is organised by aeromed, which is closely allied
to the RCDM, so from a clinical perspective we receive a phone
call from aeromed saying, "We have a casualty or a number
of casualties" and a description of the injuries. Together
with the aeromed team we make a judgment on whether they need
to come to critical care or should go straight to a ward and which
specialist ward they should go to. Aeromed decide which is the
most appropriate airport, they are flown to that airport, brought
to us by land ambulance and managed by the relevant clinical teams
when they hit our institution.
Q112 Mr Crausby: Could you tell us
what arrangements you have for the treatment of service patients
with mental health issues?
Dr Rosser: We do not provide mental
health care specifically. On the Queen Elizabeth site there is
the mental health trust but that is an entirely separate trust,
so we are not involved in the care of people with purely psychiatric
problems.
Q113 Mr Havard: But the co-ordination
of all of that is done through you, is it not, or done at your
site?
Dr Rosser: If a patient comes
back with physical injuries and psychological problems then we
will import the relevant psychiatric and psychological support,
usually via the RCDM because, as you are aware, they are quite
specialist and not necessarily able to be dealt with by civilian
psychiatric services.
Chairman: I do think you need to use
the microphone for recording purposes.
Q114 Mr Havard: Technology and children,
never work with either! The question is you are assessing that
individual in the round, are you not, you are not just mending
their broken leg or wound they have had from a bullet? That assessment
is done at your location, is it not, and then that is the centre
of the process?
Ms Moore: That is right.
Q115 Mr Havard: That gives the pathway
for the individual, is that not right? If it is not right then
it should be.
Dr Rosser: Yes, it is right.
Q116 Mr Jones: Some of the patients
we saw this morning had some very severe and traumatic injuries
but, in terms of their rehabilitation, what is the pathway when
possibly they leave Selly Oak and perhaps go into the NHS, especially
those people who are perhaps leaving the Armed Forces because
of their injuries? What is the pathway for them to ensure that
the care that you give is continued on, possibly from their local
GP or local primary care trust?
Ms Moore: The RCDM have put in
place a senior officer who is responsible for the whole pathway.
Once a patient is fit to be discharged from our organisation,
he will take over co-ordinating that care, whether it is to another
hospital, to the military, to the GP or back to the unit to make
sure that is as seamless as possible. That is all co-ordinated
by a senior officer.
Q117 Mr Jones: That is on a case-by-case
basis?
Ms Moore: Yes.
Q118 Mr Jenkins: Can I take you back
six years because originally when the Government set this system
up it was set up merely to be a contract with the MoD, so you
treat it like that: twisted ankles playing football, dislocated
shoulders, maybe some medical conditions amongst the personnel
of the Armed Forces. It was never set up to expect you as a single
unit to take the war casualties. In fact, there are arrangements
in place with other hospitals which were funded with equipment
so that we could put these war casualties across a wide range.
You have ended up with a role that you did not envisage to start
with. What impact has this had on the ability to run the hospital
normally?
Ms Moore: You are absolutely right
in what you say but what happened was with training the doctors
and nurses to go out to the frontline and the degree of expertise
and knowledge of the situation at Selly Oak and the frontline,
that led to casualties increasingly being sent back to Selly Oak
by the doctors on the frontline. At the same time, at Selly Oak
we started developing a degree of expertise in trauma injuries
that had not been seen in this country for decades. There was
a sense of pride in the staff that what we were doing was really
quite groundbreaking in some of the surgeries and things we were
doing to preserve life, preserve limb and the results coming back
that the military have had show that the clinical results are
excellent and better than would be expected. What we have done
to make sure that there is no impact on our local population is
gear up to meet that. We have put in additional facilities and
expanded our services to do that. I am pleased to say that our
waiting times for NHS patients are still amongst the lowest in
the country. We have still delivered all our targets for all our
commissioners; we have still got very high Healthcare Commission
ratings, and have done so for the past four or five years.
Q119 Mr Jenkins: Thank you. I expect
you to say the hospital is quite good, and I expect you to say
it is improving and it is the centre of excellence, but would
you agree—I am sure you will but I want to put this on the
record—that the reason they are sent back to Birmingham
is because the medical doctors in Afghanistan and Iraq recognise
this as the place they want to send their patients, they are quite
happy with it, in fact they are more than happy, so they see that
as the centre of excellence. It is through their recommendation
rather than your recommendation, and I tell you now I would rather
take their recommendation about the state of the hospital rather
than yours because you are paid to say how good you are and they
are not, they are there to look after the interests of our Service
personnel. Given that, their recommendation raises your status,
I am quite pleased to say, but the Reception Arrangements of Military
Personnel have been ignored basically in as far as we are not
sending them to any other hospitals, just yours. Do you think
we have to rethink that procedure or do you think that procedure
should still be in place because how many casualties can you accept
and when do you have to start sending them to other reception
centres?
Ms Moore: We are planning with
the MoD how we take forward the contract for the future because
we have seen an escalation in the number of casualties coming
back and at the moment I am very proud to pay tribute to our staff
who have come in on days off and who have worked tirelessly to
make sure we have always accommodated casualties. The last time
casualties were diverted was in 2003 and that was the only time.
Since then we have always managed to accommodate any military
casualties being aeromedically evacuated. What would be helpful
for the Trust would be to have certainty as to whether we are
to continue doing this for the future or, indeed, if the national
plan is to be brought into place. We are having discussions at
the moment about that.
Chairman: There are several of us who
want to come in on this question, so if you can stick to this
question.
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