Crawley

Fit for the Future Consultation Meeting held at The Friary Hall, on Saturday 27 September 2007

David Dewdney, Chairman of the East Crawley County Local Committee (CLC) informed the meeting that there were two County Local Committees in Crawley and introduced James McGough, Chairman of the West Crawley County Local Committee, who would share the Chairmanship of the Joint Meeting.

Mr McGough introduced the members of the West Crawley CLC – John Mortimer, Christopher Mullins, James Smith and Janet Sully.

Mr Dewdney introduced the members of the East Crawley CLC – Gillian Joyce and Henry Smith and passed on the apologies of Duncan Crow, who was unable to attend the meeting.

Mr Dewdney introduced Liz Tayler, Medical Director and Consultant in Public Heath, Sue Braysher, Director for Contracting and Performance and Dr Sunil Dasan, Clinical Director for Emergency Care, from the Primary Care Trust.

Mr Dewdney then asked Henry Smith, Leader of West Sussex County Council, to speak about the reasons that the meeting had been called.

Mr Smith informed the meeting that County Local Committees had been formed in March 2005 as a means for the County Council to devolve decision- making to a more local level. They were also intended to hear local people’s views on strategic issues to inform the County Council’s decisions.

The Joint Crawley CLC hosted meeting was the last of 13 public meetings hosted by the County Local Committees across the county during September and October to consider the PCT’s consultation. ‘Fit for the Future’ (FFF) proposals contained many positive aspects, including bringing many services closer to people and communities. However there was public concern about the perception that services were being downgraded.

Mr Smith emphasised that the meeting was for members of the public to ask questions and make their opinions known. The CLCs would feed back comments and questions to the PCT as part of the consultation.

Mr Dewdney thanked Mr Smith and asked Sue Braysher and Liz Taylor to briefly outline the proposals.

Ms Taylor informed the meeting that there was a clear need to change services to keep up with modern developments. Healthcare and health needs had changed greatly and the way that services were delivered needed to change to reflect this. The aim of FFF was to localise services where possible and to centralise services where necessary. It was felt that better local services would reduce the need for admission for minor injuries and illnesses. At same time, centralised services would ensure that patients received the best possible care for major injuries and illnesses.

The three options presented for public consultation considered to be clinically and financially sustainable by the PCT were:

Option A – Worthing a Major General Hospital St Richards a Local General Hospital Princess Royal a Community Hospital

Option B St Richards a Major General Hospital Worthing and Princess Royal as Local General

Option C St Richards a Major General Hospital Worthing a Local General Hospitals Princess Royal a Community Hospital

Ms Braysher informed the meeting that the PCT was at the first stage of consultation on the options. It was noted that Options A, B and C were not exclusive and that other options were actively welcomed. Professor Sir Graham Catto, President of the General Medical Council, would Chair an Independent Assessment Panel to consider any further options proposed.

The Chairman asked members of the public to present comments and questions to the PCT representatives.

Summary of Key Issues from the discussion – Questions and Answers

Question - – Member of Parliament for Crawley – A report by the Academy of Royal Medical Colleges had recommended the provision of health services on two sites. It was asked whether the provision of services across Redhill and Crawley had been considered. Answer - The Academy of Royal Medical Colleges had produced a report about national services. Local clinicians were gathering evidence about what could be done locally and that information would form part of the consultation.

Question – Local Resident – Clarification of at what point any decision was independently review was sought. Answer - The PCT Board was to make a decision based on the information and consultation. The PCT Board’s decision was subject to independent review.

Question – Local Resident – The reorganisation of health services was a huge job. It was asked whether the new arrangements would prove to be too expensive to be realised. Answer - The PCT had inherited a deficit one year ago. A recovery plan had been instigated and the deficit had been dealt with. The reorganisation of services was not about saving money but rather getting the best clinical care out of the resources that were available. Any options put forward had to satisfy clinical, financial and practicality criteria.

Comment – Local Resident – It was felt that both Crawley and East Surrey Hospitals had been very good but that they are reported to be failing. It was suggested that there was too much politics involved in the process. Response - The PCT was working in partnership to look at health proactively. Rather than being politically motivated, the process had given consultants a unique opportunity to take a proper look at services and how they can be delivered.

Question – Christopher Mullins, County Councillor for , and Southgate – Crawley has a proportionately high population in West Sussex, the majority of births will be to Crawley people. Will the major maternity unit be located in Crawley? Answer - The major maternity unit needed to be co-located with the Major General Hospital. The PCT remained open to ideas about the location of the dedicated birthing unit.

Comment – John Mortimer, County Councillor for Ifield, Langley Green and West Green – People have been told that services would improve at time of change before and rarely have they been happy with the results. The removal of services to East Surrey was promised to be positive but transport issues had proved to be very difficult for Crawley residents. The one option that people of Crawley wanted, that of a new hospital for Crawley, had not been considered. Response - A new hospital in Crawley had been considered some time ago. Most services would be provided from community facilities in Crawley or from people’s homes. It was only for serious conditions that travel to East Surrey Hospital would be required, and patients would receive the very best specialised treatment and care there.

Comment – David Dewdney, County Councillor for , Worth and , Chairman East Crawley County Local Committee – Access to Crawley Hospital from the M23 was being looked at, as was the possibility of Fastway being routed to service East Surrey hospital. Mr Dewdney invited Adrian Brown to talk about the proposals for a new hospital for Crawley.

Comment – Adrian Brown – It was suggested that there is a strong feeling in Crawley that better and more local health services are needed. A report on a new hospital had been prepared some time ago, which had been looked at more recently, based on the Brent Centre as a model. It was noted that the Brent Centre provided a range of health services within a catchment area smaller than that of Crawley and . It was also suggested that Austrian health services were considered to be excellent and also operated out of smaller catchment areas. It was asked whether that model might be suitable for the Crawley and Horsham area.

Comment – David Dewdney, County Councillor for Pound Hill, Worth and Maidenbower, Chairman East Crawley County Local Committee – The East and West Crawley CLCs would be interested in following up the suggestion of a Brent Central model of provision at a meeting in the new year.

Comment – Janet Sully, County Councillor for Bewbush, Gossops Green and Southgate – GP surgeries in Crawley are not at the same standard as those across the rest of the county. Access is a major issue for Crawley and it was a shame that there was no one from the Ambulance Service present. There is a socio-economic imbalance, particularly in the west of Crawley, that needs to be addressed. It should be a priority to have a consultant led maternity unit located in Crawley. These factors are not reflected in the PCTs consultation document and a greater focus on Crawley’s needs is required. Response - Crawley is a very important part of the consultation. There are plans to improve GP facilities in the town and work with the Ambulance Service to improve access has begun. Views on the location of maternity services will be fed back through the consultation process.

Comment – Local Resident – Crawley has been ignored in the consultation process. Nothing has been provided for Crawley and now the shuttle bus has been taken away. There are constant promises that the issues will be looked into but nothing happens. Not convinced by suggestions that the midwife led unit “could” be in Crawley. Crawley is where the majority of babies will be born and where the unit should be. Response - Crawley Hospital works in partnership with East Surrey and London hospitals to ensure that the best services are provided across the whole area. The main drive for the consultation is about community care and in that respect Crawley is as central to the consultation as anywhere else.

Comment – Local Resident – Crawley residents have a life-expectancy that is disproportionately low across the county. Services have been reduced, rather than improved in recent years. Crawley is the major economic generator for the whole of West Sussex and is not mentioned in the consultation. The consultation is primarily about saving money. Response – Crawley’s life-expectancy index is low, not in terms of ill-health, but more in terms of environment, income, housing, education etc. It’s not about saving money, it’s about looking at the skills of staff and giving them the freedom to do what they do best. Comment – Local Resident – Visiting patients is vital and has been shown to help with recovery. The shuttle bus was used more than has been suggested by staff and patients visiting friends and relatives. A major hospital facility is needed in Crawley in the event that there was a major incident at Gatwick. Response – The shuttle bus was most often running with one quarter of its capacity. 35 staff out of over 1,000 used the service. Emergency plans in the event of major incidents were in place and very impressive. The network of hospitals in the region were on stand-by for major incidents.

Question – Local Resident – People are concerned about the closure of A&E services. As an example, my wife would have died during childbirth on the way to A&E if she had had to be taken to Chichester. What studies have been undertaken on the negative impact of the proposed changes? Answer – An Independent Health Outcomes Assessment has been undertaken and the results will be considered (and published on the PCTs website) before any decisions are taken. Crawley residents won’t go to Chichester, they will go to the East Surrey Hospital in Redhill. The effect of travel times has been greatly reduced, the skills of paramedics have been improved and there are more ‘clot-busting’ drugs to keep people alive on the way to hospital.

Comment – Local Resident – Some of the proposals are very welcome, including improved GP surgeries and 24 hour nursing. It is good to have a medical consultant supporting the proposals, not just managers. The comments about a new hospital are not part of the proposals and are not viable in relation to the implications across the county. The restructure of PCTs has led to services that had been promised to the people of Crawley being removed, including the shuttle bus service. It is important that there are clear agreements as to what services there will be and that those services will remain. Response – The proposals have been developed based on international best practice and Royal College guidance. Leading clinicians have developed service models and engagement groups have developed the options. The PCT will be the commissioning organisation to ensure that services are provided and outcomes carefully monitored.

Comment – PCT Board Member – The PCT will be listening to all points of view during the consultation and it is clear that things have changed already. At the beginning of the consultation Princess Royal Hospital was proposed as a Community Hospital. Now, the retention of Local General Hospital features was being considered. Response – The Chief Executive of the Surrey and Sussex Hospital Trust had been working closely with clinicians and GPs to learn from them. It was the first time that there had been a willingness on behalf of consultants to provide cover across wider areas.

Comment – Local Resident – There was concern about the effect on the current staff. It was asked whether staff had been consulted and, if so, whether they were in support of the proposals. Following the removal of the shuttle bus, there had been discussion of a taxi replacement service. Response – It was felt that change is always unsettling but that staff were supportive of 24 hour nursing. Many staff were keen to use their skills on the people who needed them most. In respect of the shuttle bus, staff had been consulted and most had been happy to use public transport. Options for providing alternative transport for those staff who had relied upon the shuttle bus were being explored, which included taxis.

Comment and questions – Local Resident – The inherited deficit was not inherited from Crawley Hospital, because its finances were balanced. This meant that Crawley people had inherited debts from other areas and had suffered because of it. There has been less impetus to address some of the health inequalities in the area since the PCT was formed. There had been many proposals for improving GP surgeries that were not mentioned now. It was asked whether Crawley people were suffering because of the mismanagement of health services on the coastal strip. Response – There had been five PCTs previously that had now merged into one. There was a period when the new PCT needed to settle in but nothing that had been worked on previously had been forgotten about. Concern about a coastal favouritism was unfounded. Although the PCT Headquarters was based on the coast there were eight locality offices.

Comment – Local Resident – The government always talks about people’s right to choice. Crawley people choose Crawley Hospital. Response – Choice of hospital and treatment is at the centre of the proposals. The investment in services is aimed at located them closer to people’s communities and homes for those who want it.

Question – Local Resident – What will be the cost of a taxi service to replace the shuttle bus? Not everyone has a GP, which makes access to hospital services vital. Response – No details have been developed regarding a taxi service option. The option should be investigated to determine whether access to services could be provided this way at a reasonable cost. Everyone should have a GP. The proposals are to strengthen primary care, which GPs are at the core of.

Question – Local Resident – In the case of his wife, the paramedic had to choose whether to take her to hospital, which they did and she had received an excellent service. Will it be the case that less people will come to hospital under the new proposals? Response – Patients who do not necessarily need specialist treatment will not be turned away from hospital, the option to go to hospital still remains. In some cases, patients will be treated by paramedics or GPs and will not need to go to hospital. The proposals aim to ensure that where people can and want to be treated in the community the facilities are there. Comment – Local Resident – Services that were transferred from Crawley to East Surrey Hospital have increased the strain. Maternity services should be brought back to Crawley Hospital. The reason that people haven’t been using the shuttle bus should be considered, some staff travel between three hospitals during the course of the day and the shuttle bus served their needs. Response – The Major General Hospital will be the location for the main maternity service, as it needs to be on the same site as the intensive care unit. The location of the midwife-led birthing unit was as yet undecided and the PCT would be considering recommendations. Some staff travel between locations during the day and there is a scheme to reimburse them for their travel.

Summary

James McGough summarised the debate, as below:

It is fundamentally clear that health care in Crawley has been neglected in the consultation.

Crawley is an employment hotspot, an economic engine-room for West Sussex with a large and rapidly growing population. Crawley is unique as a strategic location, a gateway town with huge numbers of people using the town for travel and employment.

It was abundantly clear from residents’ comments at the meeting that a specific assessment of the needs of Crawley is required.

The factors that residents feel most strongly about include:

• The potential for a new hospital for Crawley • Access to healthcare services • The location of a dedicated midwifery unit in Crawley • The improvement of GP surgery buildings and services • An assessment of how much poor health services have an impact on other social issues in the town • That agreements that are made are binding and that structures are put in place to ensure that is the case • The curtailment of the dedicated hospital bus between Crawley and East Surrey

Primarily, it is the need to focus on Crawley and Crawley’s needs that must be addressed by the PCT.

The Chairman proposed that the summary of the meeting was sent to the PCT as part of the consultation and asked for a show of hands from those present to endorse this course of action. The proposal was endorsed by an overwhelming majority of residents at the meeting.

The Chairman thanked members, residents and representatives from the PCT for coming and closed the meeting at 12.00 noon.