IT has been billed as ‘the most important decision of the century’ – who should run Worcestershire’s community hospitals?

The resounding answer from GPs and MPs seems to be “not the acute trust” which already runs the county’s three main hospitals, including the Worcestershire Royal Hospital in Worcester.

Reservations have also been expressed about another contender – the mental health trust.

The decision will be made at Malvern College on Wednesday, September 15, at a meeting of the board of directors of primary care trust NHS Worcestershire.

Due to nationally set government deadlines, there is very little time for public and patient input, even though the decision will not only affect who runs Worcestershire’s five community hospitals but also who manages other communitybased health services.

These services include district nursing, specialist nursing in fields such as diabetes, Parkinson’s disease and palliative care for the dying, breast screening, prison health services, sexual health, the substance misuse service to help rehabilitate drug addicts and dental care.

All these services, costing £90 million a year, are run by NHS Worcestershire, the primary care trust which holds the county purse strings for healthcare.

The cash represents about a tenth of Worcestershire’s overall annual healthcare budget of about £843 million.

Until primary care trusts are scrapped in favour of GP consortiums in April 2013, NHS Worcestershire will pay for services and set spending priorities but cannot provide healthcare services directly by March 31 next year.

NHS Worcestershire runs community hospitals in Malvern, Pershore, Evesham, Tenbury Wells and Bromsgrove and other community-based services.

Who will run this so called ‘provider arm’ (Worcestershire PCT Provider Services)? There are six options on the table.

The hospitals could be run by Worcestershire Mental Health Partnership NHS Trust, which now manages Newtown Hospital and the psychiatric intensive care unit (PICU), both in Worcester.

However, concerns have been raised by NHS Worcestershire about whether a specialist organisation can take on this broader role and not all GPs support this.

Leaders at Worcestershire Acute Hospitals NHS Trust, which runs Worcestershire Royal Hospital in Worcester, the Alexandra Hospital in Redditch and Kidderminster Hospital, are also keen to take over.

But there are concerns, expressed by NHS Worcestershire, that this could lead to a monopoly situation with the acute trust, already a large and powerful organisation, running the bulk of county healthcare services.

Documents published by NHS Worcestershire also suggest that local authorities, the public and staff do not support this option.

Services could be split up with GPs running some and the mental health trust running others.

Another option is to allow private and independent sector companies to bid to run certain services or for NHS staff themselves to create a social enterprise to run local services. Some services could be moved out of the county, although this could trigger a backlash from patients.

The new-look of NHS has to be up and running by April next year, which gives some impression of how quickly change is happening.

Before the election the preferred option was to dissolve the mental health trust and set up an entirely new trust to run community services with some services transferred to the acute trust.

But the Department of Health was concerned about the cost of setting up a new organisation and this option was shelved by NHS Worcestershire.

From facing extinction, the mental health trust is now in the position where it could become far larger and more powerful, with clout to rival that of Worcestershire Acute Hospitals NHS Trust.

Dr Ros Keeton, chief executive of the mental health trust, said: “If we have an integrated organisation mental health patients have better access to physical health care services. This stops people slipping through the net.”

Dr Keeton confessed there was as yet no consensus among GPs about who should manage services but is adamant that the health service in Worcestershire would benefit from two large provider organisations rather than one large one (the acute trust).

But John Rostill, chief executive of the hospitals trust, said it made economic sense to have all the hospitals in Worcestershire run by one organisation and it has been billed by him as “the most important decision affecting Worcestershire health service this century”.

He said: “We don’t want too many competitors in the county. The best care is provided by the organisation that provides the whole of the care. There is a view that we will close community beds (in community hospitals). I have pledged that we won’t. Size is an advantage here – we’re already a large scale organisation.

“People say we have no experience of managing community hospitals. It is perfectly reasonable to regard Kidderminster Hospital as a community hospital.”

Mr Rostill said 20,000 patients in community hospitals were already treated by clinicians employed by the acute trust.

But Dr Simon Parkinson, secretary of the Worcestershire Local Medical Committee (LMC), said district nurses and community services should remain with the primary care sector and he agreed with the monopoly argument.

He said: “As far as the LMC is concerned, the option for the acute trust to take over does not meet with any support from general practice because the acute trust is an inpatient hospital organisation.”

Peter Luff, the MP for Mid-Worcestershire, said community hospitals had their own character and neither the mental health trust or the acute hospitals trust should run them.

Mr Luff wants the provider arm to become a new ‘community trust’ which would run these services but health chiefs have already ruled this out because they say it will not provide enough flexibility when GPs take over the running of the NHS.

Mr Luff said he believed the mental health trust was too fragile to run community services.

Harriett Baldwin, the MP for West Worcestershire, said: “The acute hospitals trust bears the burden of an expensive PFI contract and therefore while I can see why they are keen to combine with the community hospitals, I do not support this option. I support some services such as breast cancer screening moving to the acute trust.

People can give their feedback to the proposals on the NHS Worcestershire website at worcestershire.nhs.uk.