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The Future of Children's and Maternity Services at the Friarage Hospital

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The Future of Children's and Maternity Services at the Friarage Hospital The future of children’s and maternity services at the Friarage Hospital, Northallerton Public engagement event – Thursday 22 May 2012 Tennants Auction House, Leyburn The panel Name Role Cllr Jim Clark Cllr Clark chaired tonight’s meeting. He also chairs the North Yorkshire Scrutiny of Health Committee. Vicky Pleydell Dr Pleydell is a local GP. She is also the Shadow Accountable Officer and tonight’s lead clinician from the Hambleton, Richmondshire and Whitby Clinical Commissioning Group Fiona Dr Hampton is a consultant paediatrician and clinical director of paediatrics Hampton and community child health and was tonight’s lead clinician from South Tees Hospitals NHS Foundation Trust Many of the questions and consultant paediatrician’s comments made below were in the context of the current thinking that option 5 is the preferred option of doctors and staff working with children at the Friarage Hospital – which was discussed in detail during the presentation. Q & A What happens if a child had a tonsillectomy or other procedure as a day case but was too unwell to go home overnight? Fiona Hampton – The child would need to be transferred to another hospital. What would happen if you needed an emergency caesarean section and James Cook was full? I’ve heard that Darlington, York and Harrogate will only take planned caesarean sections? Fran Toller (a midwife and divisional manager for women and children at South Tees Hospitals NHS Foundation Trust) – I can understand people’s concerns. If a caesarean section was required you want to be assured that you would get that care from whichever hospital you went to. Wherever possible, ladies who we predict will have problems we will plan the caesarean sections and they will go on an elective (planned) list and we make sure there is a bed available. If there was an emergency section and a lady had predisposing high risk factors, she could not deliver at the Friarage Hospital in a midwifery-led unit. If she came into labour in the midwifery-led unit a transfer to James Cook would be required. Part of our planning process is making sure we have the capacity to cope with that extra workload. Vicky Pleydell – There is capacity in Darlington – if people are booked they would go. If they were at the Friarage, there would be a discussion about where they went but they would never turn someone away. How can you convince me that this is not the thin end of the wedge and that more and more services won’t be closed down and as a result we would have to go to James Cook? Vicky Pleydell – I hope I answered some of your concerns in the presentation. The clinical commissioning group (CCG) is committed to a future for the Friarage and, in my experience, the Friarage Hospital is more vibrant now than it was ten years ago – there are all sorts of services there now. There has to be a balance about what is done locally. As a CCG we would like to get more people out of hospital – we think too many people get stuck in hospital – and we have to have the care in the right place. The very high-technological care tends to be in centres of excellence. The Friarage does have its place and will provide care for the local population but we would like to provide more care at home also. The Friarage Hospital needs to stay and there is definitely a future for it. My worry is if it gets downgraded because it’s not safe or the service in paediatrics is not as safe, others will not choose to go there. That’s more dangerous for the reputation of the hospital. Can we please have district midwives again? Fran Toller – We have got district midwives or community midwives now. They are out there in the community supporting ladies, both ante and postnatal, and ladies who want a home birth. There is no impact on that service with any of these options being discussed. NHS County Durham wasted £18,000 of taxpayers’ money for advice on how to win awards. If all NHS quangos shed some chiefs, they could employ more indians so keeping more departments open! Vicky Pleydell – I can speak on behalf of our CCG and as a CCG our costs are going to be lower than the primary care trust’s costs were. Of the £1,477 that we get for each patient, £25 will be spend on CCG administration which is a tiny amount. We are very lean and are very careful about how we manage our resources. I am aware in these times that we need to save money. We work hard in our team to do the right thing. When you started speak you mentioned the stroke situation at James Cook. One of the questions I was going to ask is a neighbour had a stroke and was taken to Middlesbrough – why can’t that service be available in Northallerton? (Footnote to above question – patients now go straight to the Middlesbrough hospital for clot-busting drugs – thrombolysis – if a stroke is suspected which has saved lives and provided quick recovery. If patients have a slower recovery, they will receive their stroke rehabilitation at the Friarage Hospital) Vicky Pleydell – It’s really about the numbers. A service like this needs high levels of skills, expertise and equipment and serves large areas. It is happening all over that these services are only in specialist (tertiary) centres. There are schools of thought on this but patients do tend to be taken to the larger centres. Everyone has to travel to James Cook for this service, as well as us. Jill Moulton (director of planning for South Tees Hospitals NHS Foundation Trust) – There was a big campaign about stroke that was on the back of a whole new set of standards. Essentially these standards were saying it was better to take a patient further to a centre which can provide very well co- ordinated, well delivered services very quickly. It’s simply not possible to do that in every hospital as we need people available 24-7 to make sure patients get the right treatment. Because of this, some patients can now go home after their clot-busting injection at James Cook but if patients do need to stay in hospital, they can get very specialist stroke rehabilitation care at the Friarage. We’ve invested money there for more specialist doctors, nurses and specialists to care for this group of patients. If you have a stroke your chances of living are much higher if you’re in a specialist centre and the chances of recovery are high because you’re looked after by an expert team. We’ve actually got one of the best services in the country. There has recently been an audit and James Cook came out extremely well. I think you can be confident the care received is amongst the best in the country. (Three comments) I’m totally baffled by the shortage of money and I’ve written to William Hague to ask Andrew Lansley about this. We were told there were billions coming to frontline services. There’s a great shortage of ambulances, you increased the problem by moving trauma out last year. You’re now proposing to make the problem even worse by moving maternity services. If you can’t get an ambulance in time people will die. I would be against this move on the grounds there aren’t enough ambulances to do it. The European Working Time Directive. The Government has said they’re going to opt out of it now… Vicky Pleydell – Can I address the money issue first? The formula for money we get per capita is not changing. It’s the same as what we got last year – there is no new money coming into the health service. I think the changes are in the structure – this is about government savings. There are a lot of organisations being formed such as the NHS Commissioning Board and services which support the CCGs; public health is moving into local government so there is a lot of movement and an enormous amount of complexity. The new Bill has produced mind-blowing complexity in the NHS but in terms of funding what I will get will not go up. We all have flat-line growth next year but we have a population getting rapidly older and older people consume more healthcare than younger people. We will have to make £4.5million possible savings just to stand still. I’m seeing William Hague on Friday and I want to raise money with him and I’m also trying to see the MP Anne McIntosh. This is a political issue and William Hague is asking us to look at innovative solutions but to do that I need money. In terms of your comments about the ambulance service – ambulances are a chronic problem. As an out-of-hours doctors at Catterick Garrison I am aware of this. The day I’m seeing William Hague I am also meeting the ambulance service and I want to talk to them about how we make the service better. We need to find different ways of dealing with this. There are lots of things being done around the country which have reduced problems, similar to ours, by looking at things a bit differently. For example 999 calls – ambulances could go out and could transport patients to out-of-hours. This is not necessarily about putting another ambulance crew in Leyburn. We are modelling what all of this could mean for patients.
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