WCH Consultants set out hospital blueprint

I was most interested to see the blueprint set out this week by Consultants at West Cumberland Hospital for the services they say West Cumbrian patients need to ensure safe services in the future.

After kicking off a "Great Debate" the Primary Care Trust (PCT) is writing a so called ‘Grand Plan’ for local health services. However, doctors at WCH say there are certain essential requirements which they are concerned must be included. Otherwise, they believe “the delivery of safe emergency care cannot be guaranteed at WCH”.

The consultants want the public to be aware of these issues ready for when the health plan goes out for yet another consultation in early June. Prior to publication of the "Grand Plan", the consultants feel that Cumbria Primary Care Trust and North Cumbria Acute Hospitals Trust should commit themselves to:

- A core of consultants based at WCH in medicine/elderly care, surgery, orthopaedics, obstetrics/gynaecology, paediatrics, emergency department (A&E), anaesthetics, radiology/laboratory.

- Recognition that in order to attract and retain consultants in West Cumbria, routine procedures provided at WCH “must not become second best to Carlisle”.

The doctors also say that certain elements should definately NOT appear in the Grand Plan:

- Any intention to transfer emergency cases away from WCH other than those that already have to be;

- consultants based at Carlisle but covering WCH for emergency care.

The Consultants expect the new PCT document is likely to acknowledge there must be further concentration of specialities on one site, but unless it states clearly that WCH will get its share of those they say that recruitment of adequate numbers of consultants at WCH can not be guaranteed.

Bert van Mourik, a consultant anaesthetist at WCH, said: “The current trend is for specialities with relatively small numbers of patients to be concentrated on one site. This is hard to argue against on grounds of quality, but to date, when this has happened in Cumbria, Carlisle is chosen as that site. Unless this trend is reversed and those ‘single site’ services are shared between the two sites, WCH will struggle to retain and recruit enough consultants to provide emergency care.

“The number of consultants in all those specialities must also be enough to make the level of commitment to out-of-hours work reasonable.”

Local consultants want to see “an unequivocal commitment to the provision of emergency care at WCH, but more than that, the plan needs to show that the Trust is going to distribute ALL its services between the two sites in a way that ensures the future viability of WCH, even if that means patients travelling from Carlisle to Whitehaven for some elective services”.

Their views are largely based on Option B from a previous review of health services a couple of years ago. That option was to provide two acute general hospitals, both providing a full range of emergency services, including adequate intensive care facilities and full range of specialities.The conclusions of that review were that large scale transfer of acutely ill patients is unacceptable as it represents a “major inequity in the quality of care for patients at opposite ends of the area”.

Formal consultation into the new Grand Plan is expected to start in early June and last for three months. During this time staff and the public will be able to comment on the proposals.Michael Walker, Medical Director, with the North Cumbria Acute Hospitals NHS Trust, told the Whitehaven News that “It is vital that we can be confident that the hospital services we provide for the population of North Cumbria are not only of the highest standard but accessible, safe and sustainable. The Trust management team will continue to work with our clinicians to ensure the best possible use of both hospital sites to achieve these aims and will insure that taxpayers’ money is used to best effect in providing the sort of modern high quality services that Cumbrian residents deserve.

“In line with best practice nationally, this modernisation will mean centralisation of some highly specialised services, whilst at the same time, making sure that patients can be treated locally for emergencies and more common problems.”

I realise that the community is suffering from a serious "Consultation fatigue" having had at least five major health consultations in the past three years - indeed, I thought hte "Great Debate" consultation was still open and yet the PCT is already preparing to launch another one. However, it is incredibly important that we all take part. If we don't show that we value our local services, WE WILL LOSE THEM.

(Most of the information on this post came from Gillian Ellison and the Whitehaven News)

Conservative Health Consultation

Shadow health secretary Andrew Lansley MP has launched a three month consultation into public health. Details are available on the conservative party website www.conservatives.com

Protests on Doctor's training

Thousands of doctors took part in protests yesterday in London and Glasgow against proposed changes to the system of training. They accuse the government of trying to "disempower and degrade" the medical profession.

It is rarely the case that either side has a monopoly of wisdom or virtue. Both governments and doctors need to see the other side's point of view. But I can hardly blame doctors being fed up with the government when Tony Blair describes anyone who dares to disagree with his proposals for the NHS as "the forces of Conservatism" and leaves Patricia Hewitt as Secretary of State when she is the only person in the country who things the NHS is having it's "best ever year."

We will not sort out the problems of the NHS unless we can make real improvements in doctors and nurses morale and convince them that they and their expertise are valued. That particularly applies in remote areas like West Cumbria where recruitment and retention of key staff is vital to retaining services.

To start the process of improving morale will require a genuine two-way communication between government and medical staff. That is not happening at the moment. This government's idea of consultation is letting you know what they have decided.

The Conservatives have started a three month consultation on public health. Details will follow here shortly.

£50 million to upgrade WCH

It has been announced that a full upgrade to West Cumberland Hospital would require £50 million. The NHS Trusts also admit that there is a £30 million maintenance backlog.

The people of Copeland are entitled to know how that situation arose, and what the comparable costs are for a new hospital.

The NHS Trust should publish more details both of what is included in the costs of refurbising WCH, and the costs of a Greenfield Site option.;

"Great Debate" continues

The formal date for the Cumbria and Lancashire CATS consultation has now gone, but the "Great Debate" continues - and I am reliably informed that the Primary Care Trust (PCT) have said they are considering extending it further.

So you can still send your views on CATS or anything else relating to the future of NHS services in Cumbria to the PCT by following the link at the right.

Have you had difficulty posting to this blog ?

I gather that one or two people have had difficulty leaving comments on this blog or using the email link to contact me.

If you have had any such difficulty, please drop me an email by typing the following address into your email programme -

chris4copeland@btinternet.com

and please start the email title with "Communications Problem."

Alternatively, if you have had a problem using the internet to respond to this blog or otherwise contact me, please feel free to phone me. Knowing how search engines for lottery scammers and other nuisances trawl the internet for telephone numbers I am not going to post my number here, but I am in the latest North Cumbria BT telephone book.

News from the doorstep - Don't Move our Mums!

The most striking message from the doorstep while I have been canvassing in Whitehaven has been the extent of concern about maternity services at West Cumberland hospital.

I mentioned a couple of days ago that a one lady living in the Bransty area of Whitehaven said to myself and my colleage Alex Carroll, that if West Cumberland Hospital had not been here at the time of more than one of her pregnancies, she and her children would have died.

This evening, another lady made quite independently to us an almost identical comment along the lines of

"If our hospital had not been here a few years ago when my baby was born neither I nor he would be here today."

It's not just a coincidence. When you stop to consider it, the idea of taking a thousand pregnant women a year forty to sixty miles along some of the worst trunk roads in Britain to give birth in Carlisle does not bear thinking about.

CATS consultation - TWO DAYS TO GO

The CATS consultation is open for another two days: Reponses to the consultation should be submitted by 5pm on Friday 9th March.

Details are available on the internet at

www.cumbriaandlancashirecats.nhs.uk

and you can respond online.

They can be sent in online by visiting the above consultation website, or by post to

Freepost RRHA-BEGG-LSLE
CATS public consultation
Room 3 Preston Business Centre
Watling Street Road
Fulwood, Preston
PR2 8DY.

If you care about the hospital services at West Cumberland hospital in Whitehaven, Millom Community Hospital, or Mary Hewetson Cottage Hospital in Keswick, this affects you.

Making sure we still have a hospital

Today's Sunday telegraph magazine included an item by Sandi Toksvig.


She starts the article with a family joke to the effect that people have been concerned about the shortage of fully qualified theatre staff for her local hospital since the hospital put up a sign which says "Guard Dogs Operating."

Then she added

"Mind you give it five years and it won't be the sign we remember but the fact that we used to have a local hospital."

In the past 48 hours I've heard remarkably similar concerns expressed by people three hundred miles apart who were worried about the future of their local hospitals. Both at the AGM of Jersey Farm Residents Association in St Albans and while I was on the doorstep in the Bransty area of Whitehaven, people were expressing concern about whether local services are safe. And they were right to be concerned.

There are no easy answers in the management of the NHS. But there are some senior managers in the NHS who are too quick to see service provision in terms of a choice between local provision and world class provision.

Sometimes we should refuse to accept that this is the choice. For example, it is unacceptable to roll over and agree that we have to go along with the alternatives of retaining a maternity unit in West Cumbria and accepting that it won't be world class, or to force 1,000 women a year to travel forty miles over some of the worst trunk roads in the country to give birth. I met a local resident yesterday who was convinced that both she and her baby would have died if those were the only options.

Part of the job of governments and NHS managers is to make difficult choices. But sometimes when presented with a choice between intolerable options, the correct answer is not to accept the unacceptable, but to refuse to accept any of them and go away to make a more acceptable choice possible.

If we want the government to do that, we need to keep up the fight for our hospital services in West Cumbria

As NHS staff protest against hospital cuts

Hospital staff throughout Britain have been protesting today about cuts in jobs and services.

One nurse is quoted on the BBC website as saying "I have been in nursing for 23 years and have never known morale to be so low"

Morale is an absolutely fundamental issue, because maintaining good hospital services is not just a matter of spending money or of keeping hospital buildings open, important as those things are. It is necessary to recruit, train and retain a skilled, professional work force, and this in turn is much easier if they are motivated, feel valued, and believe the people running the NHS have a positive vision for the future.

It is quite extraordinary that, at one and the same time, taxpayers are paying massive and enormously increased amounts of money for the NHS, and yet the experience of both patients and staff in many parts of the country is threatened or actual cuts in services, ward closures, and job losses.

Two of the reasons for this apparent conflict, which has applied under both this government and the previous one, are the consequences of good things - the availability of new (though sometimes expensive) drugs and treatments and the fact that people are living longer.

People who would once have died at fifty or sixty are now living to eighty, or are having a much improved quality of life due to better health because of new treatments: this is an excellent thing but in the process there is a huge extra demand on the resources of the NHS which is constantly having to review how it uses money and people to meet that demand.

Some of the other problems of the NHS are less easy to defend. Vast resources are going on administering the government's 400+ NHS targets and their complicated regime for inspections and awarding stars. And although I am in favour of the principle of working with the private sector to improve NHS services, the practice has not beeen as succesful as patients and taxpayers need and deserve. PFI initiatives such as the PFI hospital, the Cumbrerland Infirmary at Carlisle, have not always delivered what was required, and have often meant that future taxpayers over the next thirty years are being landed with cumulative bills for PFI hospitals which are many times what those hospitals are worth.

A strategy to deliver a better NHS must include at least the following three elements.

First, there must be a dramatic simplification of the targets and inspection regime, and the targets which are retained should concentrate more on outcomes (such as survival rates) than process (such as number of operations. Resources taken away from administration must be concentrated on the patient-facing services.

Second, we need a more realistic approach to hospital beds. It may well be that in a more ideal world in which hospital services were perfectly efficient, we could deliver a better service with fewer hospital beds. But the NHS is not perfectly and efficient and mortal human beings will never make it so; and failures in other services will mean that there will always be "bed blockers" in hospital beds who should be supported in other ways.

If we provide NHS hospitals with the number of beds that a perfectly efficient service would require, rather than the number of beds needed given the level of effectiveness which is humanly attainable in practice, there will be dire consequences of which continued high levels of deaths due to MRSA and other hospital acquired infections, and poor morale among the nursing staff who have to try to fit a quart into a pint pot, will be only two of the most obvious.

Third, we must give doctors and nurses as much freedom as possible to run their hospitals in a way which fits the specific needs of their patients and listen to their expertise. Too many health ministers have the idea that anyone who disagrees with them is at best misguided and at worst sabotaging the service. We need a less stalinist approach to NHS management.