UK, NHS, Dorset: The Clinical Commissioning Group Consultation Document - and the future role of Dorset County Hospital.

Comments and observations on the NHS Dorset Clinical Commissioning Group Consultation Document - and the future role of Dorset County Hospital. 

A lot of work went into the preparation of this formidable 48-page document, containing the proposals for changing the organisation of local community and hospital-based services in Dorset, and the enclosed 8-page consultation questionnaire.

I’m not sure I have the energy to fill in the tightly-structured questionnaire, which asks for one box only to be ticked in answer to each question, with allowable multiple choice responses from Strongly Agree to Strongly Disagree, or “Don’t Know”.

The Commissioning Group has clearly decided what the preferred options are (and will probably turn out to be). That’s what it seems to me.

At the bottom of page 1 of the questionnaire, the group writes: “Our preferred option is for 7 community hubs with inpatient beds; and 5 community hubs without inpatient beds but providing a range of outpatient and other service, spread throughout the localities in Dorset”.

“Doing nothing is not an option”.

Page 8: “We have difficulties staffing some services because there are national and local shortages of some medical staff with key specialist skills and it is difficult to recruit to some posts. This includes GPs, mental health nurses, consultants working in accident and emergency and paramedics. We also face the prospect that quite a lot of staff are coming up to retirement age in the next few years. We are now trying to recruit staff from other countries such as Portugal, Spain, Italy, Ireland and the Philippines.”

There is no mention of all the uncertainties around the issue of the free movement of people, following the referendum vote for Brexit and the possible outcome of negotiations following the triggering of Article 50.

Today’s print edition (7 January 2017) of The Guardian newspaper carries a headline article: “NHS faces 'humanitarian crisis' as demand rises, British Red Cross warns”, which helps to put the NHS situation in context -  see https://www.theguardian.com/society/2017/jan/06/nhs-faces-humanitarian-crisis-rising-demand-british-red-cross

In the Dorset consultation document (p. 11) it states that the vision for change includes the aim that “more care would be delivered closer to home, reducing the need to travel”.

One of the main proposals (p. 12) is to provide “a different way of providing urgent and emergency care services…so that we can save even more lives and improve care”.

A major ‘option for change’ involves the creation of “community care hubs” for outpatient appointments (p. 17), an alternative to admission to acute hospitals (p.19).

For Mid Dorset, the Dorset County Hospital in Dorchester would become a community hub without beds (p.23).

That is confirmed on page 27: Dorset County Hospital would be a community hub without beds (but “also an acute hospital”). It’s not clear to me how it can be an acute hospital and a community hub without beds.

                                                                                                                 

If “an acute hospital”, would it be a hospital for ‘moderately’ major planned care, or a (moderately) major emergency hospital?

Page 30: “We propose that Dorset County Hospital would remain a district general hospital serving the west of the county and be largely the same as it is now. However it would form part of a Dorset-wide set of networked clinical services with Bournemouth and Poole. The most seriously ill or injured patients needing specialist care would be transferred to the major emergency hospital in the east of the county”.

The group’s proposals include two options for how acute hospitals might be organised differently. Both options A and B include Dorset County Hospital as a “planned and emergency care hospital” (page 31).

But on page 23 it is stated that Dorset County Hospital would become a community hub without beds.

On page 32 it is states that 95% of  Dorset’s population (the population being defined as including all people whose nearest acute hospital is in Dorset - meaning that a large part of the Dorset population might be nearer to Yeovil, Somerset or a hospital in another county?) can reach services at Bournemouth (as the major emergency hospital) within 30 minutes by blue light ambulance, and that 90% of people can reach it within 30 minutes “by peak time private car” (80% could reach Poole as the major emergency hospital within 30 minutes by peak time private car). The percentages might be considered a little misleading or skewed, given that the major population centres in the county are in the Bournemouth and Poole areas, in any case. Isn’t 40-55 minutes a more realistic peak time estimate for many people?

The consultation document points out (p, 32) that “travelling times to the acute hospitals need to be considered…”

Bournemouth is the preferred option for future development as the major emergency hospital, based on all the financial criteria (with Poole as the ‘planned care’ hospital).

This option also allows for continuation of support to Dorset County Hospital as a “pivotal provider” for planned and emergency services in West Dorset (page 33).

It is not clear to me what the group means by “a pivotal provider”, given some of the ambiguous and contradictory statements of Dorset County Hospital’s future role earlier in the report.

Given the fact that those patients suffering from an emergency such as a heart attack or a stroke need to be admitted to hospital and treated within half an hour, that amount of time being of the essence, would a patient from the county town of Dorchester, let us say, or further afield, be taken straight to Bournemouth, or to Dorset County Hospital?

Would the staff at Dorset County Hospital have the specialist training, support and equipment to deal with such life-threatening emergencies?

A case study is provided on page 39. “Barbara is 75 and has a stroke in the early hours of the morning at home in Puddletown”. The likely scenario now is that she is taken by ambulance to Dorset County Hospital, her nearest local hospital. But upon arrival she is assessed and treated by the general emergency doctors who are available on site.

Under the group’s proposals, Barbara would probably be taken to Bournemouth, “where she would have access to highly skilled, specialist staff 24/7”. Then “she would be transferred back to her nearest local hospital as soon as it was medically safe to do so”.

But Dorset County Hospital, even if categorised as an acute hospital (albeit not a major one), is described elsewhere as a community hub without beds.

The big question remains: could Barbara, or other patients, really reach the ward, and/or receive specialist emergency treatment, at the Royal Bournemouth Hospital within 30 minutes? I ask again, isn’t 35-40 minutes travel time a more realistic peak time estimate?

Shouldn’t the preferred option be treatment at Dorset County Hospital, with properly-trained staff always on duty?

A final thought: if one hospital is designated as the major emergency hospital for the whole of Dorset, however much it is expanded or developed, won’t the queues for treatment and waiting times at A and E quickly become unmanageable, leading, at worst, to the risk of  'black alerts'?

Today's news about the NHS:

The Telegraph - 'Humanitarian crisis' in NHS warns British Red Cross as A and Es are overwhelmed by demand

Elsewhere:

Woman dies after 35 hours on hospital trolley amid warnings of NHS 'meltdown', The Telegraph -

"Yesterday the trust running the hospital announced plans to centralise A and E services at the overloaded unit, downgrading another local casualty unit".

Update:

'The worst conditions in memory': NHS doctors describe a week in AandE, The Guardian

Update:

Campaigners hit out at hospital plans as Dorset CCG holds public consultation event in Bridport, Dorset Echo - 'David Jenkins, lay member of the Dorset CCG board, said: "We have been pleased with the number of people who have been good enough to give up their time at this event.
"I am very pleased that these proposals are for a general hospital with a high range of services to continue in Dorchester."Mr Jenkins also confirmed that talks were continuing between Dorset County Hospital and Yeovil Hospital to explore the possibility of working closer together".

So why is there no mention of Yeovil Hospital in the consultation document?


About the Dorset CCG Consultation document -

Maybe I’ve misunderstood, or simply missed something…

I hope others will take the trouble to fill in this important questionnaire and return it before the deadline, by Tuesday 27th February 2017. You can also fill in the form online at www.dorsetsvision.nhs.uk

I'll look at it again, although I feel I've raised some relevant queries, in the interests of both clarity and transparency.

A doctor's viewpoint - Dr. Jon Orrell

Update:

Dorset: Clinical Services Review, Claims and Counter-Claims about Travel Times from West Dorset to Bournemouth and Poole


Some Campaign Graphics:

PM in America: Before her speech reporters asked the prime minister she would be willing to make it easier for US businesses to deal with the NHS if that was the price of a trade deal with Trump. “As regards the NHS, we’re very clear as a government that we’re committed to an NHS that is free at the point of use,” she said, failing to rule out such a move but also making it clear that any discussions were yet to begin. This prompted Labour’s Jon Ashworth, the shadow health secretary, to call on the prime minister to confirm that “a rushed trade deal with President Trump will not be a Trojan horse for NHS privatisation”.