It has taken some time for some of the cutbacks proposed by the Sustainability and Transformation Plans drawn up behind closed doors in 2016 to percolate through, but a new round of downgrades and cutbacks in Accident & Emergency services appear to flow from the need for massive savings – and from the continued chronic failure of government or NHS England to tackle the growing shortages of nursing and medical staff.

Indeed staff shortages are the convenient excuses put forward for fresh efforts to downgrade A&E departments in Tyneside, Lancashire, Gloucestershire and Cambridgeshire.

South Tyneside

In Tyneside the Northumberland, Tyne, Wear and North Durham STP set out plans in response to a claimed £641m gap in the health system by 2021: NHS staff, unions and campaigners warned of concerns that

“… with references throughout the STP to the need to reconfigure services and the problems sustaining seven acute hospital sites, that the South Tyneside FT and Sunderland FT coming together to be managed under a single management could be a prelude to a merger in which one hospital or the other would be downgraded – leaving patients from the other area to travel much further for treatment.”

The two trusts have merged, and now, as predicted, the pressure is on to strip out services from South Tyneside Hospital to “centralise” them in Sunderland.

Some stroke, paediatric and maternity services have already been moved to Sunderland – but more services are at risk: the next phase of the so-called “Path to Excellence” scheme involves changes to emergency care, surgery, diagnostics and outpatient services, effectively downgrading South Tyneside to an elective treatment centre with urgent care.

Since 5th August children’s A&E services in South Tyneside Hospital have been closed between the hours of 10pm and 8am: this will affect 3,600 children a year. Senior consultants in the trust report that the numbers of children attending A&E almost quadrupled from 6,000 in 2012 to 21,000 in 2018. Every cutback further undermines the hospital’s future as a District General Hospital.

The only reason holding up this next change is the shortage of capital. But astoundingly it seems that local councillors could step into the breach and enable the trust to go ahead. Ken Bremner, chief executive of the merged Trust, has said if NHS funding is not forthcoming local councils could offer support to the scheme.

In July campaigners took to the steps of South Shields Town Hall to protest at the possibility of South Tyneside and Sunderland councils using their borrowing powers to raise up to £50m capital … to fund changes that would further cut back their own local hospital services. The lion’s share could come from South Tyneside Council.

Save South Tyneside Hospital campaign chair Roger Nettleship warns that the main reason for this is because NHS chiefs “want the council to buy-in to this second phase without knowing what it’s going to be. If they buy into it, then they’re most likely to not oppose the services that will be lost. The scrutiny committee did a brilliant job to oppose the phase one when they referred it to the secretary of state. There won’t be that same impetus to do that if they’re funding phase two.”

Chorley

In Chorley in Lancashire the process of downgrade of the Chorley and South Ribble District Hospital is more advanced: its A&E closed completely for much of 2016 citing staff shortages, and depite the efforts of campaigners is now functioning only for limited hours.

A new document assessing 13 options for the future of hospital services in Chorley and Preston was published on August 22, but while it claims to be “clinically led” it notes (pages 9-10) that its preferred options have been precluded by a lack of capital and the financial plight of the trust which ended last financial year £46m in the red.

The report concludes it’s not “clinically viable” to retain accident and emergency facilities at Chorley: but “It is clear from high-level clinical activity modelling that the population health requirements could not be serviced by one of the two current hospitals” – and there is no money to build a new hospital or expand either to cope.

Of the 13 options only one, Option 3, includes reopening services which have already been closed at Chorley – emergency surgery, inpatient paediatrics services or obstetric-led services: it’s clear that this is not the favoured option, and others continue the downgrade of the hospital. The report warns:

“As a programme, we recognise that some of the options described in this paper may be difficult for some people to accept. The changes proposed will be difficult, but it is necessary to resolve the issues that we described in our Case for Change.”

The cutbacks at Chorley have had knock-on effects on surrounding hospitals as far away as Bolton. Earlier this year Preston Hospital consultants, part of the same Lancashire Teaching Hospitals Foundation Trust as Chorley, wrote to trust executives and used social media to raise concerns about its struggling emergency services, which have been among the worst performing in England against the four-hour target.

Hinchingbrooke

In Cambridgeshire the first steps towards downgrading A&E services at Hinchingbrooke Hospital, which has been merged with Peterborough 24 miles away into the North West Anglia Foundation Trust, have begun – despite repeated categorical assurances during the merger in 2017 that services would remain on existing sites, and that merger was the only way of maintaining A&E at Hinchingbrooke.

The financially-challenged Cambridgeshire & Peterborough STP is now proposing to close all trauma services at Hinchingbrooke, forcing patients to travel either to Peterborough or Addenbrooke’s hospital in Cambridge, 23 miles way. This removes a key component of the A&E service, and will strengthen local concerns that it could be further downgraded, using the pretext of staff shortages.

Cheltenham

West County ITV reported at the beginning of August that “Plans to close Cheltenham’s A&E department” had been confirmed by the town’s MP.

Conservative MP Alex Chalk warned that the proposals would downgrade the accident and emergency department to an Urgent Treatment Centre, and set up a petition against the changes. He said that it was a “bad proposal” and “a flawed way of engaging about it”.

Three days later, after the level of public anger became obvious, and as the political situation made an impending election more likely, ITV announced what appears to be simply a temporary reprieve: “Safe for now? Plans to close Cheltenham Hospital’s A&E service have been delayed”.

This has to make us wonder about political strings being pulled: how long will the reprieve last? and how many more downgrades are waiting in the wings?

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John Lister
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