On the availability of ECMO facilities for the Northwest:
· Currently the NHS system is about to enter a period of flux. Current government intends to make GPs solely responsible for allocation of NHS funding.
· At the current time the question of an ECMO device in the northwest falls under the auspices of the Strategic Health Authority, headed by Mike Ferrah.
· ECMO would fall under ‘specialist comissioning’ and it is unclear whom would be responsible for this under the new NHS regime. No decisions possible until this is resolved.
· There are staff at Wythenshaw hospital trained to run an ECMO device, but there is no machine on that site at present.
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Our aim therefore is to influence the regional decision making process at work in the northwest.
· If the current government allows the old system to remain in place until more details of the new system are properly established we may be able to persuade Mike Farrah to look at implementing ECMO for the Northwest before he leaves his position.
o Andy Burnham has sent a letter to Andrew Lansley to this effect.
· It may also be possible for Mike Farah to push ECMO in the northwest through before he leaves office if he acts promptly.
· If not it is unclear who we will need to contact.
· Andrew Lansley the current health minister is in a precarious position due to the lack of details in the white paper on the new NHS he published. If he backs down he risks loosing further credibility. He may not hold the post for much longer, adding further instability.
· At present our best option in the near term is to persuade Farrah to try to push ECMO through. If he cannot we will have to wait to see how the NHS vs LHS (‘Local Health Service’) situation progresses.
o In this case it may be possible to seek assistance from vulnerable patients groups.
· As staff are present then the only objection is the cost of aqquiring an ECMO device. We may be able to overcome this directly by means of a fundraiser, which Andy Burnham will support.
· John Freeman will start a blog to promote ECMO in the northwest, and to promote a possible fundraiser.
· Andy Burnham will ask Chief Exec of University Hospital South Manchester what the current position and impression is on ECMO.
Questions we wish to put to Mike Farrah:
· Before you stand down is it possible for you to push through the issue of funding for an ECMO in the northwest.
· Is it possible to convince the NHS to fund an ECMO device for the northwest, or shall we proceed with the fundraiser?
· Is there any indication where ‘specialist commissioning ‘ will fall under in the new NHS system?
· What is current situation with the civil service shutdown?
· How can we proceed if we do find ourselves working in a purely market forces driven system?
Case for ECMO:
· A well understood technology, which has been used for 40 years.
· Has a wide range of applications, not just the (debated) application to acute respiratory distress.
· Has been cited as directly linked to the survival of a Scottish woman with H1N1, who was transferred to Sweden where ECMO is more available.
· Is particularly applicable to at-risk infants.
· Is a logical compliment to existing facilities.
· Many patients to whom ECMO may have been applicable were caught in a catch 22 situation, as Susan and Gemma were: If the patient is well enough to travel the distance to the ECMO device they are deemed not in enough need to warrant its use. If they are in dire need then any form of travel will likely kill them. Susan could not be moved fifteen meters down the corridor.
o This demands a Northwest hub for ECMO, as well as greater availability nationwide. Patients dying, grieving families left in doubt as to effectiveness of care, due to an easily foreseeable catch 22 situation is not acceptable for the 2nd best healthcare system in the world.
With regards to Susans case specifically?
o We would like a breakdown of the decisions made during the 9 hours she waited between admission and the C-section.
§ Was a transfer to an IC specialising in the area of her illness considered.
§ If not, why not, given that Hope IC is a head trauma specialised unit, and moving her post C-section would always be more risky.
§ If it was considered, where would she have been transferred to?
o Why were we discouraged from researching ECMO? Such discouragement itself raises questions about the source; If ECMO is truly ineffective our own research would have confirmed this.
o How many H1N1 cases did hope have at the time of Susans illness? What was the survival rate?
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