Bridlington, Barnstaple and Canterbury, and more? …
One reason it has become so hard to find detailed information on planned cuts to local NHS services is that, as soon as any such information becomes available, the public shows their readiness to fight in defence of local hospitals and services.
Moreover, when the public offer a challenge, many of the planned “centralisations” or rationalisations of services have proved poorly conceived and based on unsound assumptions that do not stand the test of time.
There are several ongoing localised battles over the closure and downgrading of local services in various parts of the country – regardless of the stated reason for the closure.
In Bridlington on the Yorkshire coast Humber and North Yorkshire Integrated Care Board opted last month to defy the calls from local campaigners, East Riding of Yorkshire council and Unite the Union, and press ahead with the permanent closure of Bridlington Care Unit (BCU) a rehab ward, and move to a “community-based” model of care.
York and Scarborough Teaching Hospitals NHS Foundation Trust, which runs Bridlington Hospital, also declared its support for closing the unit, despite acknowledging that 91 per cent of people surveyed during the public consultation opposed the closure.
ICB chief executive Clare Smith said:
“The Board has supported the [closure] recommendation because patients who no longer need acute hospital treatment should, wherever it is safe and clinically appropriate, be supported to return home as soon as possible and with the right package of care around them.”
The problem is that nobody in Bridlington is convinced services are in place in the community to ensure the “right package of care” is available to all who need it, and therefore question how it can be judged “safe and clinically appropriate” to discharge patients back home.
The BBC reported Dr Anthony Clarke, chair of the Bridlington Health Forum, which has opposed the proposals since they were announced, stating this clearly:
“Within the forum, we do agree that patients should not remain in hospital if they can be safely cared for out of hospital. But until there’s clear evidence of strengthened community services, we oppose the closure.”
The East Riding opposition, also driven by concerns patients could be left without adequate support, also called for the plans to be paused until adequate care was in place.
The fact that no such services are yet available was underlined by the trust pledging it would now publish further information on “the implementation timetable, transition arrangements and ongoing engagement opportunities once these have been confirmed:” in other words, much needs to be done before the closure can be safely carried through.
Unite points out that establishing these services is out of the Trust’s control:
“The trust says that patients not needing acute services will receive community-based care, which it does not have responsibility for and does not pay for. Unite believes this attempt to generate short-term savings will not outweigh the long term costs due to patients being readmitted to hospital because of the gaps in community care provision.”
Of course in the absence of sufficient supporting services, there will also be more delays in discharging patients from acute hospitals. In response to the ICB decision Dr Clarke has warned:
“The effect of closing the unit will be to put more pressure on hospitals like Scarborough Hospital, York Hospital, and increase the congestion within the hospital, increase the occurrence of corridor care and make it harder for patients to be admitted from A&E.”
ICB boss Clare Smith was less than convincing as she brushed aside overwhelming local opposition and dismissed the widespread fears that the closure of the BCU would be followed by the rundown and closure of Bridlington Hospital.
Sounding like a football club chairman expressing faith in a manager who is about to get the sack, she told the local news:
“We want to be clear that Bridlington Hospital remains an important part of local healthcare provision, and we have been actively working to increase the services that are available there, particularly in planned surgery and outpatients. This decision is specific only to the BCU and does not impact the future of the wider hospital site.”
In North Devon Hospital in Barnstaple, the ‘temporary’ closure of an under-staffed and unsafe maternity unit has also caused local outrage, as expectant mums in the north of the county now face an agonising hour and a half (or longer) 55 mile trek to Exeter, or out of the county (50 miles) to Taunton to have their babies.
Hundreds of people came together at The Square in Barnstaple town centre on August 15 to protest against the closure, which the Royal Devon University Healthcare NHS Foundation Trust (RDUH) insists is due to staffing issues which they say they have tried, and failed, to resolve.
There are local fears that the closure may prove to be permanent, despite the Department of Health & Social Care insisting to Health Service Journal reporter Emily Townsend that maternity unit closures must be temporary and not “irreversible”, with any plans for service change clearly outlined.
The extent of doubts on how solid the promises may be that the unit will reopen is indicated by the fact that the RDUH medical director, Dr Karen Davies, resigned in protest at the decision, saying she could not “support the way the trust has handled, and is handling, the maternity situation” at Barnstaple hospital.
Dr Davies’ resignation letter stated:
“We have known for several years that there have been concerns about fragility, as well as safety and culture, in the northern maternity unit.”
A proposal for additional support which “could have produced a plan to avoid closure” had not been followed, and “… my repeated warnings and concerns over the last two years have not been heard and have not been acted upon.”
With 910 births last year Barnstaple’s is the smallest of 25 units in England that deliver fewer than 2,000 babies a year). According to Royal College of Midwives chief executive Gill Walton, it was unusual compared with other cases because it was about not having enough obstetricians rather than low levels of midwives.
Devon County Council’s Health and Adult Care Committee has discussed the ‘extremely concerning’ closure, and Council leader Julian Brazil has criticised the closure, saying:
“Some remote parts of North Devon are a two-hour drive from Exeter – and that’s when there is no traffic or road closures. This closure is extremely concerning. It is not a decision which would be countenanced in other parts of the country and we should not accept second-rate NHS provision here.”
At the end of August a cross-party group of five MPs whose constituents use maternity services at the Royal Devon and Exeter Hospital (RD&E) wrote to Health Secretary Yvette Cooper over the potential impact of the Barnstaple closure.
The letter, led by Exmouth and Exeter East MP David Reed, asks what assessment has been made of the number of additional patients who may need to use the RD&E and what effect this could have on staffing, bed availability and existing capacity.
They are also seeking details of contingency arrangements if demand exceeds current projections, including whether extra staffing and resources would be made available; and they want to know how patient safety, quality of care and waiting times would be monitored if pressure on services increases.
Meanwhile early hopes that RDUH might reopen the services on 29 September have been dashed: Trust bosses have now said the service will remain closed, with services reviewed fortnightly, as they were not in a position to reopen as anticipated.
Geography is also a key factor in the growing concern over future services in East Kent.
Care Quality Commission reports have downgraded both of the major A&E units, Queen Elizabeth, the Queen Mother Hospital in Margate (where urgent and emergency care had not been assessed since March 2018 were re-rated inadequate for safety) and the William Harvey Hospital in Ashford (re-rated on four out of five criteria as ‘requires improvement’).
However, the most central hospital, Kent and Canterbury, has only an Urgent Care Centre, and it is being steadily downgraded as specialist services are diverted elsewhere. Campaigners are now warning that its St Lawrence Ward, a 24‑bed complex‑discharge ward at K&C, is scheduled to close at the end of this month.
Staff were informed only recently, and it is understood that no full HR support or redeployment information has yet been provided. A CHEK (Concern for Health Equality in Kent) campaign press release on August 28 emphasises the potential impact:
“This closure will leave significant bed capacity empty just as winter pressures begin. Combined with the planned relocation of both stroke wards to William Harvey Hospital next year, Canterbury is set to lose three large wards, with no clear plan to replace the lost capacity.”
At the end of July the East Kent Hospitals University Trust which runs all three hospitals declared a critical incident, due to an IT issue, warning that patients attending emergency departments for non-life-threatening conditions may experience an “extremely long wait.” The reality is that both QEQM and William Harvey are frequently under serious pressure – and can’t afford to see capacity reduced.
From April 2028, Dover, Canterbury and Thanet will form one new East Kent council, and QEQM in Margate, rated inadequate, will be the only full 24 hour A&E located within the new East Kent Unitary area. CHEK campaigners are calling for a re-evaluation of the controversial plans, consulted on 8 years ago, which continue to remove beds and specialist care from Canterbury.
They note a new Mechanical Thrombectomy Suite has been installed at Kent & Canterbury Hospital: but the system has been set up to ensure maximum delay and minimum integration.
“It’s a huge step forward for stroke care in East Kent — patients with a large‑vessel clot can now get life‑saving treatment locally instead of being sent all the way to London.
“But here’s the part the NHS didn’t mention:
“If the ICB moves the Hyper‑Acute Stroke Unit (HASU) to William Harvey Hospital (WHH) in Ashford, a patient with a suspected stroke will be:
- Blue‑lighted to WHH
- Scanned
- If a large clot is found, blue‑lighted back to Canterbury for thrombectomy
- After the procedure, transferred back to WHH for HASU care
“That’s three ambulance journeys, two hospital transfers, and critical time lost.
“… It makes no clinical sense to move the stroke unit away from the thrombectomy centre. No other stroke network in England separates these services — because it’s unsafe.”
A petition opposing the transfer of the HASU to Ashford notes:
“The 2018 stroke consultation excluded Kent & Canterbury Hospital on the grounds that a HASU must be co‑located with an A&E. Yet stroke services have been safely delivered at K&C since 2020, with significantly improved outcomes and national recognition. This proves the original rationale was flawed. After eight years, with major changes in service configuration, population need, and clinical evidence, a new consultation is essential.”
On July 31 local MP Rosie Duffield wrote to Health Secretary Yvette Cooper, questioning the continued work to relocate stroke services
“despite the instruction from the Kent and Medway Joint Health Overview and Scrutiny Committee that no work should proceed [on the HASU relocation] until its scrutiny had been completed.”
Ms Duffield also stressed the reliance on outdated evidence “including a business case developed several years ago …”. She also points out the rapidly growing population in the area, its “well-documented GP shortages, increasing pressure on emergency departments and growing demand for rehabilitation services,” and calls for investigation of the decision-making process, the evidence underpinning the plans, and whether there has been appropriate “governance, scrutiny and public engagement.”
The battle continues.
However what each of these three examples shows is that where a concrete issue or proposal is brought to the attention of the public there is substantial interest and willingness to fight back where local services are seen to be at risk.
The Lowdown again invites anyone with hard information on how cuts are working through at local level to contact us and share the details, so we can help to build awareness of what is at stake, and follow local campaigns as they grow.
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