A Proposal for the Future Configuration of Acute Services in Worcestershire

Introduction:

This proposal is an alternative to that put forward by the Worcestershire Acute Hospitals NHS Trust. Its themes are viewed from those areas covered by services at the Alexandra Hospital. These include the area covered by Redditch Borough Council, Bromsgrove District Council and those parts of South Warwickshire which border Redditch. Geographically it includes Wythall and Hopwood to the north, and Studley and Alcester to the south.

This document addresses the proposals put forward by the Worcestershire Acute Hospitals NHS Trust and why this alternative proposal should be considered.

Government Policies referred to:

• Treatment to be as near to where the patient lives as possible.
• Payment to hospitals by results.
• Patient choice.
• Cutting levels of carbon emissions.
• European Working Time Directive.

Proposals of the Worcestershire Acute Hospitals NHS Trust (as at 01/11/06):

• To centralise Obstetrics at Worcester.
• To centralise inpatient Paediatrics at Worcester - retaining daytime assessment and minor operations at Redditch.
• To centralise emergency Gynaecology at Worcester.
• To transfer the Trust Headquarters from Worcester to Redditch.

Arguments for the proposals:

• They help to address the Trust's financial deficit of 32million.
• They improve clinical quality.
• They address staffing difficulties under the European Working Time Directive.
• Improved senior management access to the Worcestershire Primary Care Trust which is based in Redditch.

Arguments against the proposals:

• The financial savings against the £32million deficit has been declared by the Trust to be less than £2million.
• Capital development costs for the proposed 'Women's Hospital' on the Aconbury Unit at Worcester has been estimated at £20million.
• Increased pressure on capital and pay costs for the Ambulance Trust.
• Clinicians acknowledge that there is an increased clinical risk for women, children and unborn babies having to travel an extra 20 miles from Redditch to Worcester, a minimum of 40 minutes.
• Increased risk for women and babies requesting home deliveries in the north of the county because of the extra distance to the maternity unit in Worcester should this be necessary.
• Increased stress for women in labour by extra distance to the maternity unit.
• Increased stress for parents and sick child because of distance to the paediatrics ward.
• Increased stress because of the extra distance for parents wishing to be with a child at Worcester and commitments to other children in Redditch, Bromsgrove and local areas in South Warwickshire.
• An estimate that 25% of all households in Redditch have no private transport. Public transport is poor and the average cost of a one-way taxi fare in the evening from Worcester to Redditch is £36. This may compromise the ability of some families to visit relatives in Worcester at times of great anxiety; this is not conducive to the psychological health of the patient or the family as a whole.
• There will be increased pressures on car parking at Worcester which is already problematic.
• There will be an increase in carbon emissions caused by the increase in cross county travel.
• Mothers and children will have less choice of where they will be treated.
• Some will choose to go to Birmingham Hospitals because of better public transport, so reducing further the income to the Acute Trust.
• Clinicians in Paediatrics at the Alexandra Hospital have great concerns that they will lose their skills if only relatively minor procedures are carried out there.
• With cross-site cover, obstetrics and paediatrics have enough staff to work according to the European Working Time Directive.
• The Chairman and Chief Executive of the Acute Trust have acknowledged publicly that the present services are not unsafe.
• No account has been taken of the planned increase in population in the county.
• The Trust has been in discussion with Doncaster and Bassetlaw Foundation Trust. If this Trust has been selected for 'benchmarking', then, by referring to the Doncaster and Bassetlaw profile, there are firmer arguments not only for retaining the present services at the Alexandra Hospital, but also for upgrading them.

These proposals therefore do not conform to the government's policies on local treatment, patient choice and reducing carbon emissions. The capital and revenue costs of developing the Worcester site vastly outweigh the savings of contracting inpatient obstetrics and paediatrics on to one site. There will be an increased capital and revenue cost for the Ambulance Trust. The present services are not unsafe but clinical risk will be increased for women, babies and children by the extra travel distance.

An Alternative Proposal

• Maternity Services to be kept local.
• Paediatric inpatient and outpatient services to be kept local.
• All emergency services to be kept local.
• The Acute Trust Headquarters to remain at Worcester.
• Centralise elective operations, especially for cancer.

Benefits of this proposal

• No multi-million pounds capital costs would be necessary. The Trust Board can communicate with the PCT electronically.
• There would be no increase in work load for the Ambulance Trust, so relieving it of extra capital and revenue costs.
• The clinical risk to children, mothers and babies would not be increased by extra travel.
• It would enable maternity and paediatric services to be offered to families in South Birmingham and Warwickshire, with a possible increase of income under payment by results policy.
• It complies with and exceeds the recommendation by Professor Sir Alan Craft about retaining a 24 hours stay paediatrics ward at the Alexandra Hospital.
• There would be no increase in clinical risk for home deliveries in the north of the county because of increased distance to a maternity unit.
• It implements more effectively Government policies of locality care and cutting carbon emissions.
• It does not increase psychological stress for parents and families as the transfer of services to Worcester would.
• Already elective services have been centralised eg vascular and haematology at Worcester and urology at Redditch. To increase the scope for centralising elective care means that patients and their families would be able to plan alternative care of vulnerable elderly people and other children.
• The development of rotational working in maternity and paediatrics for clinicians and nurses would enable more staff both to retain their skills and also gain skills and experience in highly stressful areas, interspersed with time in less stressful areas. This method of working may prevent some staff sickness.
• Rotational working for clinicians across the county would enable compliance with European Working Time Directives.
• Centralisation of cancer surgery at Worcester would complement the present centralisation of haematology on that site and if the Trust's bid for radiology services at Worcester is successful then to create a centre of excellence for cancer services would seem to be sensible. We would, however, see outpatients and day chemotherapy services remaining locally. By centralising inpatient cancer services there could be developed one cancer network for the county not three as at present.

These proposals do not necessitate added capital and revenue costs to the health economy in Worcestershire. They comply with Government policies on treating people as locally as possible particularly at times of heightened stress due to emergencies involving children and women in labour. They maintain patients' choice to have their child delivered at home with readily accessible inpatient maternity services. They enable families to visit their sick children and maintain care of other children in the family free from the worry of separation due to the extra distance needed to be travelled. The proposals would comply more readily with Government policies on reducing carbon emissions and they would also enable clinicians and nurses to develop a wider range of skills as well as enabling the Trust to comply with the European Working Time Directive.

Bromsgrove and Redditch Church of England Clergy.

Save the Alex Action Group.