Future of hospitals under review

Buy photos » A major shake-up of healthcare in the county could see big changes at Worcestershire Royal Hospital.

A RADICAL overhaul of healthcare in Worcestershire will lead to the county losing one of its accident and emergency departments and could see other services being severely downgraded.

Health chiefs say they are facing a £50million shortfall in the next few years caused by Government cutbacks and an ageing population and are carrying out an in-depth look at how hospital care could be delivered from 2015.

This week, as part of the Joint Services Review (JSR), they unveiled six different models which look at how services could be provided in the future.

However, two of the options to retain full A&E departments at both the Worcestershire Royal and the Alexandra Hospital in Redditch are thought to be unworkable because of the growing financial strain.

Currently there are no specific details about which sites services would be located on in each of the four remaining scenarios

but potentially in three of them the A&E service, maternity, women's and children's services would be centralised in Worcester or Redditch.

In the remaining case, one hospital would close altogether with just a minor injuries unit and outpatient unit provided in the area.

Health chiefs warned that without change there was a real risk services would deteriorate as in future they would not be able to recruit enough specialist staff to meet clinical guidelines or be able to afford new treatments and drugs.

Doing nothing has been ruled out by bosses as recruiting enough consultants to meet new guidelines would cost Worcestershire Acute Hospitals Trust (WAHT) a further £3.5million.

The models have been drawn up by clinicians with the help of outside experts since the review was first announced in January.

Different and more affordable ways of delivering better standards of elderly care, planned care, emergency care and women's and children's services were among the areas examined.

Penny Venables, chief executive of WAHT, said the trust was still in the early stages of the review process and no decisions had been made.

"This is about engagement to try and explain to the public why we are doing it. At this stage there’s a lot more detailed work we need to do before we start being specific about what the implications are.

"We need to look at the financial cost but we haven't done that work or level of detail yet," she added.

Chris Fearns, JSR project director, added: "There’s no blueprint behind closed doors. We haven’t come down on any specifics, it is absolutely as transparent as we can make it."

A series of public events are now being held, including one at County Hall on July 7 between 10am and 2pm, so residents can comment on the principles behind the plan.

Feedback from the event will be used to draw up options which will go out to public consultation in September ahead of a final decision in December. Any changes would be introduced by 2015.

Visit www.worcestershirehealth.nhs.uk/joint-services-review to find out more about the proposals.

THESE are the clinical models being consulted on:

One acute / emergency hospital site (with a full A&E dept)

One acute site with urgent care centre

One hospital treatment centre with MIU

The acute site would have a full A&E and trauma services, emergency medicine, women and children’s services as well as facilities for complex emergency surgery, the most complex planned surgery, outpatients and a full range of support services including diagnostics, pharmacy, laboratories, physiotherapy and rehabilitation.

A second site would offer an urgent care centre and would assess adults referred by their GP or brought in by ambulance with urgent but less complex medical problems. It would also see and treat patients with minor injuries. It would have no emergency surgery facilities. Some patients might need to be transferred to the first site for emergency treatment if their condition got worse.

The second site would also provide most of the outpatient services and planned surgery, along with the appropriate support services. There might be the possibility of a Midwifery Led Unit depending upon whether enough experienced midwives could be recruited and there is sufficient demand to make the service affordable. There would be a children’s rapid access clinic available during daytime hours which GPs could refer to and which would be supported by a children’s community nursing service.

In this model there would be no change to the Kidderminster Treatment Centre.

One acute / emergency hospital site (with a full A&E dept)

One hospital site providing planned surgery with MIU

One hospital treatment centre (includes planned surgery) with MIU

The acute hospital site would be the same as above.

A second hospital site would change to focus on planned surgery, along with the support services this would need including some high dependency care, diagnostic and laboratory facilities. It would also provide a Minor Injuries Unit and outpatients. There would be no facility to see or assess adults with urgent medical problems and no emergency admissions. There might be the possibility of a Midwifery Led Unit subject to the criteria set out above.

There would be a children’s rapid access clinic available during daytime hours which GPs could refer to and which would be supported by a children’s community nursing service.

In this case the separation of emergency care from most planned surgery should reduce disruption of planned surgery due to emergency admissions, and mean the numbers of cancelled operations are dramatically reduced.

There would be no change to the Kidderminster Treatment Centre.

One acute hospital site (with a full A&E dept)

One hospital site providing planned surgery with MIU

The acute site would be the same as in the other two models but would be supported by a range of new primary care and community services. These services would offer care and treatment closer to home and improve care quality and patient experience. They could also provide care which is better integrated with other local services such as social care and mental health teams.

A reduced number of hospital sites will improve recruitment and achievement of the right numbers of consultants to maintain minimum quality standards in all specialities.

Emergency care for the most severely ill patients would be via a single emergency hospital site. Access to planned surgery would reduce from three sites to two sites. However outpatient and diagnostic services would be available in the three existing towns as at present.

A Minor Injuries Unit would be maintained in the third town although not necessarily on the existing site. There might be the possibility of a Midwifery Led Unit. There would be a children’s rapid access clinic available during daytime hours at the second site and in the third town which GPs could refer to and which would be supported by children’s community nursing services.

One acute hospital site (with a full A&E dept)

One acute hospital site with services as set out in the previous models.

A Minor Injuries Unit, outpatient’s and diagnostics facility would be maintained in the second and third towns, although not necessarily on the existing hospital sites.

There might be the possibility of a Midwifery Led Unit. There would be a children’s rapid access clinic available during daytime hours in the second and the third towns which GPs could refer to and which would be supported by children’s community nursing services.

From learning elsewhere, the single hospital site model will greatly improve recruitment and achievement of the right numbers of consultants to maintain minimum quality standards in all specialities.

Emergency care for the most severely ill patients will be available at the single emergency site. These patients would travel by ambulance to their nearest A&E.

It is expected many patients would be able to receive treatment and care through services provided in their own communities which would minimise the need to travel for hospital care.

Regional news »