Published at 15:45, Wednesday, 29 July 2009

CONCERNS raised by hospital doctors, community leaders and unions have been addressed by health bosses in an open debate. Unison representative, Christine Wharrier, raised the fact that changes to pathology services had not been discussed. “There are objections and I believe that it should be put to a public meeting. It does not tie in with Closer to Home,” she said. “The problem is it’s a downgrading of a hospital, bit by bit we are eroding services.” Gerard Richardson said: “We got assurances that we would not have a steady drip-feed of service. Is there a drip-feed of service to Carlisle?” MP Jamie Reed asked what the issues were surrounding recruitment and why it was proving so difficult to attract staff to North Cumbria. Ross Forbes, corporate affairs director for NHS Cumbria (primary care trust), told the meeting of progress within community care. He said: “The Copeland step-up/step-down unit (community beds at West Cumberland Hospital) has opened and is working successfully. The Copeland MP praised the Trust for the work it had carried out regarding finances and the hospital. He added: “I do think that this new management is carrying the can still for a lot of what happened with the previous management team.”

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In a meeting chaired by Copeland MP Jamie Reed, after being called by the Save Our Services group, a lot of issues were thrashed out in the hospital boardroom.

And The Whitehaven News was invited along to hear health chiefs reaffirm their commitment to West Cumberland Hospital, its services and Closer to Home.

They said there had been misinformation circulating in the hospital about out-of-hours emergency services.

Setting the record straight, lead surgeon at the hospital, Mike Walker, said they were exploring a less than 24/7 emergency surgery service for the West Cumberland Hospital, as agreed in Closer to Home.

He said it would be based on need but that no detail had yet been discussed.

Mr Walker said: “All patients will come to the West Cumberland Hospital whether it is in or out-of-hours and be assessed here.”

If a decision was made that emergency surgery was required and it was out-of-hours then, he said: “If they are unstable to travel (to the Cumberland Infirmary) then a consultant will come here (to the West Cumberland Hospital).”

Normal working hours could be, for example, 8am-9/10pm weekdays and 8am to 5pm weekends, he said.

Consultant anaesthetist, Ian Ulyett, asked if such a patient required an intensive level of care would they have to go via ambulance to Carlisle.

Mr Walker said: “It will be decided on a case by case basis, in some cases they will go there and in other cases the surgeon comes here. It will not be the case that surgeons won’t come here.” He said if someone was unstable then the surgeon would come to the patient.

It would mean that West Cumberland Hospital would still provide a 24-hour consultant-led emergency medicine care but not 24-hour surgery. “The frequency to transfer patients for out-of-hours operations will be very small.”

He said only a very small number of patients are ever operated on out-of-hours, that the aim for any hospital is always to operate in-hours.

Rev John Bannister, the Save Our Services spokesman, said this was as he had understood the situation to be under Closer to Home and that it would be for a small number of patients only.

When Rev Bannister asked why it was necessary, Mr Walker explained that it was to ensure there was a clinically safe service and robust out-of-hours rota for vascular and emergency surgery. He said there would be eight surgeons on the rota for out-of-hours surgery (with two on at any one time) that will cover the whole of North Cumbria. He said the hospital would still have a resident operating team available 24/7.

Charles Brett, A&E consultant, said there has never been any suggestion the A&E service would be reduced, that it is consultant-led and would remain so. “We are signed up to deliver the services outlined in Closer to Home and look forward to being an integral part of that.”

The subject of emergency out-of-hours surgery would be discussed at length and a plan agreed with consultants, said Mr Walker, before being tested on, for example, a nine month basis.

The North Cumbria University Hospitals Trust said its internal communications had been revamped recently and now included management walkabouts, questions time sessions for staff and forums.

Mr Walker said: “Communication has broken down and we need to make sure that it is better.”

Gerard Richardson, of the Save Our Services group, said: “Is the hospital we are planning now any different to the hospital we were promised?

Carole Heatly, Trust chief executive, said: “No. We are committed to everything in Closer to Home.” She said the only changes there would be is if they were for clinical safety reasons, and such a decision would be made by the clinicians themselves.

David Hounslea, project director for the £100million hospital redevelopment, said visible work would be evident by the end of the financial year.

He said there would be an improved environment on wards, efficiency changes so that services were grouped together properly and that views from the hospital would be maximised on wards.

Car parking would also be better he said but he warned to expect some disruption as work was carried out. “We will bring it to the top of the site where it is accessible and we want to bring buses onto the site so that patients can be dropped off outside the front door,” he said.

After the meeting, Rev Bannister said he was excited about the new hospital plans, however, he “remains concerned at the possibility of even more clinical services transferring to Carlisle, despite the previous agreement reached that this would not happen”.

He added: “Not all senior clinicians employed by the Trust are in favour of the continued provision of split site services and therefore I remain concerned that we will see a gradual movement of more clinical services to Carlisle.

“It is, I believe, time for the Trust to fulfil its earlier assurances of providing a balance of clinical services on both hospital sites.”

The North Cumbria University Hospitals Trust is no longer to carry out post-mortems at West Cumberland Hospital, instead, the deceased will be transported to Cumberland Infirmary for the procedure.

They say that it will mean quicker results for families as well as helping to improve cancer services for all patients in North Cumbria as more time will be devoted to patients instead of travelling.

Kevin Clarkson, Trust deputy chief executive, said: “I have no problem if any one wants to call a public meeting and have my team stand up and talk about post-mortems and cancer.”

He said three histopathologists currently carry out post-mortems and one of them, Fergus Young, had reported that they were not achieving cancer standards and therefore had brought some proposals to address the issue. “Do we look at the needs of the larger living or the deceased?” said Mr Clarkson. “We decided to go with the larger living and deal with dignity with the deceased.”

He said they were offering incentives to try and attract histopathologists to the area but that they could not fill vacancies. “If we get to six histopathologists (there are currently four) then we can do post-mortems on this site,” he said, adding that the move was completely clinically-driven and not to save money.

Nick West, consultant haematologist, said: “The problem is that your advisers are nearly all Carlisle-based, on a smaller site I think it is felt that we are not adequately represented.”

A&E consultant Charles Brett said: “I am 110 per cent behind what Kevin has said, it will improve the quality of the service for the patient.”

Health bosses are centralising some microbiology services to Carlisle which means that certain tests would be transported there to be analysed on behalf of patients at West Cumberland Hospital instead of being done on site. A ‘hot lab’ facility however would remain to ensure that emergency specimens could still be done there and then on site.

Consultant orthopaedic surgeon, Mahesh Dhebar, said: “I think we should retain this service.” And a hospital physician said he did not want to have to telephone around for test results for a suspected acute meningitis patient as he would require them within 30 minutes. “We are very stretched on the floor with regard to juniors and seniors and if juniors are required to ring Carlisle for results then that is not an efficient service.”

Mike Walker said that would be sorted out to make sure the service remained efficient.

Regarding pathology, Mr Clarkson said: “It is not a loss of service. There will be a quicker turnaround time for people in West Cumbria and for cancer work.”

Nick West, said he thought there was a drip drip of centralisation of services regarding histopathology and microbiology. “It’s a loss to this hospital and this community. Each one is a little drip drip which demoralises staff and doesn’t help recruitment.”

Mike Walker said services needed to be safe and that occasionally it would mean that services have to be delivered from another site.

But Soonu Verghese, consultant ophthalmologist at West Cumberland, said: “All the drip drip has been towards Carlisle. Why can’t management think about services coming this way? It has to be a two-way process. People should be made aware of the fact that they will have to travel. A lot of my patients are elderly.”

Carole Heatly said: “If we build a purpose-built eye hospital here and the majority of patients are elderly and there is a higher population in Carlisle, what do you think the population in Carlisle would say?”

Liz Twist, Unison regional representative, added: “There is a real concern over here about the drip drip of services. People fear that even with a great building that the hospital may not provide all the services. So it would be good to open early dialogue with staff and address issues.”

Kevin Clarkson said: “People are not applying to Cumbrian posts. We are not down-grading the service, we are trying to build it up and make things sustainable for the workforce. We are continually advertising.”

Carole Heatly said: “There are national shortages of histopathologists. We also cannot get anaesthetists and it is a major worry. We are really trying to promote the area and get doctors to come and work here.” She said the Trust had even made a DVD to send out promoting its hospitals and the area.

Mahesh Dhebar said: “Unless you guarantee the future of this place (West Cumberland Hospital) you will not recruit. Unless you have a hospital that will be there 40 years from now, you will not recruit. Also, there are problems recruiting to a split site (ie two separate hospitals).

Rev Bannister said there were underlying and historic reasons why hospital staff and the community were often concerned about hospital services. “For the 10 years I have been here there’s been fear over this hospital. I am not sure we will actually be able to alleviate that until the day the (redeveloped) hospital opens its doors.

“We have a responsibility not to hijack this process with issues that do not warrant public concern.” But, he added: “The Trust needs to look at its communication policies.”

“We have got rapid response teams in Copeland and Allerdale.

“Throughout the county we have created around 170 jobs in the community.”

He also said the PCT had invested £10million through its GPs, which are now in charge of spending the budget.

Plans for community hospitals revamps were under way, he said, towards the end of the year it was hoped that a site will have been chosen for the Millom hospital.

Mr Forbes said acute hospital admissions were going down as a result of improved community services.

He added: “There are big issues for staff as they move from an acute setting into the community in terms of learning new skills.”

Lisa Drake, locality manager for Copeland, said the new Copeland unit had opened on July 5 and that there had been 28 admissions.

She said staff had also accompanied some patients home after they had left the unit.

Lesley Carruthers, the university Trust’s deputy director of nursing, said the length of stay of patients was reducing and that nurses had more time to care for patients instead of having to focus on discharge plans for them.

Seascale GP Barrie Walker said there was now a better co-ordinated service. “Lots of things are happening, we are looking after patients quicker and sooner and patients are getting a better service.”

“We have to look to the future,” added Dr Olu Orugun. “We have to plan for what the population needs for the future and it is going to be different. We have an opportunity which to me is exciting. He said, however, that there needed to be a strategy in place to deal with patients who have both mental health problems and acute problems.

Trust chairman, Mike Little, said: “Our Trust Board is committed entirely to this hospital here at West Cumberland and all its services. There is £100million coming to this hospital.

“We need support for moving this hospital forward. We have got a contractor, we are making a start. But as we go through the next few years there’s going to be far more problems than we are discussing here,” he warned. “There are always financial issues, we have to live with them. Our board has turned around this Trust.”

Carole Heatly added that nationally there was going to be a significant reduction in the amounts of government money coming into the NHS so it would mean that things would have to change.

“We can do this together and we can make this a success. If we don’t, it will be a disaster,” she added.

Mr Reed responded: “I will oppose every single cut that’s suggested.”

Liz Twist, of Unison, added: “If we sign up to this approach we need transparency and openness. People are entitled to know what’s proposed by the NHS and enter the debate.”

Published by http://www.whitehavennews.co.uk