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

Dr Andy Slater
Dr Andy Slater

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.”

He 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.

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

He added: “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 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, adding: “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: “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 starts on Monday (June 25). It will run for 14 weeks, until midnight on Friday, September 28. There will be series of public events. For more information visit www.esht.nhs.uk/shapingourfuture.

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