Hospital changes are aimed at a ‘gold standard’ of care

PATIENTS will have to travel up to 20 miles for emergency treatment under new proposals to reconfigure several services, hospital bosses have admitted this week.

Substantial changes are set to be made to general surgery services, musculoskeletal and orthopaedic services, and stroke services.

Up to 15 patients a day will have to travel either to Eastbourne or Hastings, NHS bosses said, if the proposals come into effect.

General surgery deals with abdominal organs, such as the stomach and intestines, and the higher risk and emergency work will be based at either the Conquest or DGH.

Emergency orthopaedics, such as fractured hips, would also be centralised at one or the other hospital, similarly with stroke services.

But Dr Andy Slater, joint medical director at East Sussex Healthcare NHS Trust, which runs both hospitals, said the trust’s vision was to create a ‘gold standard’ of health care.

He said it was too early to speculate on the future of maternity services as proposals had yet to be drawn up.

Dr Slater said: “We are absolutely committed to providing two acute hospitals that give the services our population needs. We have taken a real honest look about how we provide these services, what we are actually providing, and how we can improve it to bring about a gold standard of health care.”

Dr Slater said the trust consulted with leading clinicians, the Health Overview and Scrutiny Committee (HOSC) and patients’ groups before coming up with the current proposals.

He said: “One of the things that leapt out at us was no consistency on how we provide services, which is completely unacceptable, in that you receive different care whether it’s on a Monday to Friday or at the weekend. We have to provide the same high quality care seven days a week.”

Dr Slater also said one of the biggest problems facing the hospital trust was a shortage of specialist doctors and nurses, and those who have qualified, choosing to work elsewhere, rather than in Hastings or Eastbourne.

He said: “We have found this, despite having the funding, and that has been incredibly disappointing. There are other hospital trusts out there with a similar vision to provide a gold standard of care and they (newly-qualified doctors) are choosing to work there.”

Dr Slater said there needed to be a ‘critical mass’ of patients to ensure the service was viable to run. In other words doctors and nurses needed to have plenty of patients in order to keep their specialist skills up.

He said: “Across the trust we have around 750 stroke patients a year but that does not give the specialists that critical mass to practice and maintain their skills. In London there were around 30 stroke units and these were reduced to eight, which provided high acute stroke care and over the last 18 months around 400 lives have been saved directly as a result of this configuration. The average length of stay has fallen and quality of life indicators have shown a clear and dramatic improvement in care.”

Dr Slater said in London trusts have been able to ensure that around 15 per cent of stroke patients were now seen and treated with clot busting drugs within four-and-a-half hours, whereas here the rate was only three per cent.

He said it was because the trust simply did not have enough specialist doctors and nurses in that field.

“This is all about being able to attract, recruit and retain specialist doctors and nurses,” he added, “In a year’s time there will be specialist stroke nurses seven days a week, 365 days a year to meet the patient on admission and put them through the process so they have a CT scan within an hour.”

Dr Slater said the trust had a small number of surgical consultants at both the Conquest and DGH, which meant they were only working on an emergency capacity every four days. He added, because of this, operations were being cancelled and emergency patients’ treatment was being delayed.

He said: “We have got the right number of consultants across the trust for the work to be done but they are not in the right place for them to do that efficiently.”

Dr Slater stressed there were no plans to downgrade A&E at either the Conquest or DGH. He said the trust was, in fact, planning to invest in new A&E staff at both hospitals.

He said: “We do not have enough A&E consultants and are looking to increase that number to five Medical Assessment Unit consultants at both sites. We are also investing in more consultants in acute medicine and orthopaedic geriatricians, who can look after general surgery patients.”

Dr Slater, however, said there were many cases where patients were being admitted to hospital unnecessarily. He said: “We need to ensure that patients with long-term conditions are supported at home and given additional support in the community as an alternative to coming into the hospital. If they need to come in, we need to make sure that we have senior clinicians so treatment can be started as soon as possible.”

Dr Slater said the proposals would equate to one stroke patient a day having to travel almost 20 miles to the other hospital, around five to six for general surgery and around three to four in the case of orthopaedic and trauma services.

He said: “We have huge sympathy and understand the inconvenience for patients having to move between the sites but the quality of services they get in return will far outweigh this.

“But it cannot be a question of playing cards. We should make the decision that will benefit all the patients in East Sussex so this is why we are asking the public for their views on where these services should be sited. We are looking at the demographics and travel time. This is not about winners and losers, it’s about providing high quality care for patients in East Sussex.

“Outpatients appointments will stay where it’s most convenient for the patient and that includes every speciality. If you need an X-ray or other test, that again will be at the hospital most convenient to you, as well as day-case surgery in any of these three services.

“If the patient has all but the highest risk surgery that needs to be done, that will be carried out at the hospital most convenient to them.”

Public consultation on the proposals starts on Monday (June 25). It will run for 14 weeks, until midnight on Friday, September 28.

During this time there will be a range of opportunities for people voice their views. This will include a series of public events throughout the county. The times and venues for these events will be publicised locally as well as being available at www.esht.nhs.uk/shapingourfuture.

During the consultation there will be meetings with local politicians, public representatives and organisations.

The proposals are contained in the public consultation document Shaping our Future which will be widely distributed across the region. Leaflets summarising the plans will also be made available.

- Cut out and display your Hands off the Conquest poster opposite to show support for the Observer campaign launched last week