Lack of details and empirical evidence

It is vital that the trust share with the general public all of the data and information used within its consultation excerceses and publictaions. Without this data we cannot easily validate the robustness of their arguments. To date, the Trust has not shared this information without the Action Group having to resort to using the Freedom of Information Act.

Suggested Reconfiguration of Services does not reflect local issues.

This proposals do not reflect local issues, e.g. poor daycase rates for Redditch and Bromsgrove PCT, or realistic choices; e.g. Redditch and Bromsgrove people may choose healthcare in Birmingham over healthcare in Worcestershire, particularly if services are moved from Redditch.

Free Choice

There is little attention paid to 'free choice' which may result in more activity being undertaken at other providers, particularly independent sector providers - both for elective work and diagnostics. This is clearly linked to recent capacity planning exercises.

Indeed, the consultants at the Alexandra Hospital recently put together a proposal to take over the running of the hospital independently from the trust. However this was flatly rejected by the Trust Board, event though this may have resolved many of the issues facing the Alexandra Hospital.

Lack of Holistic Vision

Any attempts to improve productivity through reduced lengths of stay/admission prevention cannot be viewed in isolation and need to be part of a whole system approach to the management of both scheduled and unscheduled care. Existing community care systems are largely geared up to respond to current productivity levels. Alteration of productivity e.g. shortening length of stay will alter the level of community support required. Whilst there may be some scope for dealing with marginal improvements in productivity, any step change in performance will require a corresponding increase in investment in community/primary care services both in terms of additional community nursing capacity and support from general practice and also social care. We cannot find any reference to this additional cost within the trusts documents.

Impact of these changes is not just on NHS organisations but also on Social Services. Social Services signup to the proposals together with a recognition that there may be increased community and social costs of implementing them is key.

Documents produced by the trust are not a health economy view of the problem, rather an acute view. Many of the proposed solutions have knock-on effects in community services, and may require additional funding. This aspect does not seem to have been considered.

Any new work must take a whole systems approach. Shifting costs from the acute sector to the community will not solve this problem long term.

Domino Effect

The 'domino' effect needs to be considered - A&E without paediatrics is unsafe. Combining the two A&E departments is, we consider, unfeasible. Transfer of paediatric trauma from the north of the county to Birmingham is also, we understand not feasible. Hence we believe that paediatrics and A&E should remain at the Alexandra.

Costs

Costs incurred in changing services have not been taken into account, and have not yet been officially published. However, 20 million is not an unreasonable figure required to move Maternity services to Worcester.

Trauma

Without medically staffed A&E services, trauma could not operate out of the Alexandra.

A&E

Without paediatric support, A&E would be significantly compromised.

Transport

70% of emrgency admissions to the Alexandra are through A&E. Shifting this to WRH may simply add pressures to transport systems, which would have to be funded through the health economy.

Future Trends

Likely future trends, particularly an ageing population and greater expectations, need to be taken into account in modelling any new proposals?

[Many of the above issues were origionally documented by the Redditch and Bromsgrove Primary Care Trust]