Review of Hospital services in North Cumbria

The review of maternity services, and possible disastrous move of consultant-led maternity facilities away from West Cumberland Hospital, is one of a number of options raised in proposals published by the North Cumbria University Hospitals NHS Trust on Friday.

One in five children needing hospital treatment could also be transferred from the West Cumberland Hospital to Carlisle’s Cumberland Infirmary according to the report.

AS explained in the previous post, the same draft document says that no firm decisions have been made on maternity services, but two out of three options to be considered would see patients in west Cumbria losing their obstetrics department altogether.

These are just two of the proposals outlined by the trust in charge of North Cumbria’s hospitals.

The ‘clinical options appraisal’ has revealed its suggestions for how to tackle the areas of care it feels are most at risk – without which it says it will not be able to emerge from special measures.

While North Cumbria University Hospitals NHS Trust stresses this is just a draft plan and is now open to consideration by the public, it does also outline the trust’s preferred options for overcoming major difficulties in recruitment and safety concerns.

This appraisal document is the result of months of work by senior clinicians and has been published following a special meeting of the trust board on Tuesday.

Paediatrics, acute care, maternity services and outpatients are the key areas being tackled.

In the executive summary, chief executive Ann Farrar writes: “The trust remains open-minded to consideration of alternatives which can demonstrate they better meet the current challenges.

“However, and, to be clear, this document focuses on what the trust, to date, believes could be the potential way forward based on the evidence available.”

About 18 children a day are treated at the West Cumberland Hospital. The trust’s favoured option proposes retaining a 24-hour short-stay paediatric assessment unit at the site, supported by a full inpatient unit at the Cumberland Infirmary.

It says that “more than 80 per cent of children would still receive their care locally in Whitehaven”.

The issue of maternity is far less clear, as the draft document says no decision or preferred option will be made until after an independent review is carried out next month.

However, it does state: “In advance of this review and further work, the challenges are considered by the board at this early stage to be such that a two-site model appears impossible to deliver against current regulatory guidelines and NICE guidance.”

There are already serious concerns in West Cumbria following the decision last year to transfer trauma patients to Carlisle. Those fears are likely to be exacerbated as one suggestion by the trust is to transfer or divert more groups of high risk patients – such as stroke, internal stomach bleeds and emergency cardiac patients – from the West Cumberland to the Carlisle hospital.

Dr Jeremy Rushmer, medical director at the trust, told the Whitehaven News: 

“Our most critical issue is acute medicine at West Cumberland Hospital and the fragility of this service should not be underestimated.

“The potential solution we have outlined, to transfer certain patients to Carlisle, will not only help us provide a sustainable model of care that is robust in the long term, this will also help us attract aspiring candidates, working as part of wider clinical teams, to west Cumbria so that we can stabilise the local workforce.”

The initial estimates say there would be an additional three transfers per day between the sites.

However, a second option would be not only to transfer these acute patients, but also to limit the number of patients brought to the West Cumberland Hospital.

This could be limited either by postcode or by shutting off the hospital to admissions between 9pm and 8am. This would involve an additional 11 patients a day being transferred to Carlisle.

While the trust prefers the first option, it says that either proposal – in whatever variation – would free up beds at the West Cumberland, ease the pressure on staff and allow the hospital in turn to focus on building up its outpatient appointments.

The trust wants to increase the amount of “uncomplicated planned surgery” taking place in West Cumbria and says its proposals could see an additional 4,000 appointments a year in Whitehaven.

Dr Rushmer said: “As our staff, patients and the public would expect, we simply cannot ignore concerns which have been raised to us by our regulators in relation to clinical standards and expectations and we now must work together to tackle these issues once and for all. Change, by its very nature, is always difficult and we recognise the challenge this brings, particularly for our staff who continue to put their patients first and respond fantastically well embracing the challenges faced on a daily basis.

“We also recognise concerns raised by the local communities and we are committed to engaging with people fully over the coming weeks and months.

“Our ambition for north Cumbria is to deliver the safest and highest possible quality of care for the communities we serve and to make our hospitals as good as, if not better, than the best in the NHS.

More details on the Whitehaven News site here.