Health service changes in county - for better or for worse?

The reconfiguration of health services in Worcestershire has been a controversial issue for three years, particularly in Wyre Forest where Kidderminster General Hospital was stripped of its status to make way for a state-of-the-art Worcestershire Hospital due to open early next year.

This week marks the first anniversary of the Kidderminster downgrading.

So the Shuttle/Times and News asked Worcestershire Health Authority and Wyre Forest MP Dr Richard Taylor for their thoughts on the new-look service.

The authority was also speaking on behalf of Worcestershire Acute Hospitals NHS Trust and Wyre Forest Primary Care Trust which are overseeing the changes.

Paving way for care in 21st century

THE past year has seen many changes in the ways in which healthcare is provided for the people of Worcestershire.

The county is moving towards having some of the finest facilities available in the country with patient care being provided by first class clinical teams.

The new Worcestershire hospital is due to open in less than eight months and plans for the ambulatory care centre in Kidderminster are progressing well.

The Alexandra Hospital in Redditch has seen major changes with a full refurbishment of its accident and emergency and outpatient departments, as well as opening two new operating theatres to enable the development of orthopaedic and urology services.

As part of the service changes, a minor injuries unit was introduced at Kidderminster a year ago, with emergency nurse practitioners now assessing and treating over 60 per cent of patients who previously attended the department.

They use computerised telemedicine links to gain immediate expert opinions from the A&E consultants at Worcester and Redditch.

As part of the service changes a new medical assessment unit opened at Worcester to ease the pressure on the accident and emergency department and to improve the care of patients admitted as medical emergencies.

The consultant-led unit, supported by senior nurses, is open 24 hours a day to assess, diagnose and treat medical patients.

There is now a new vascular centre, including a dedicated theatre, at Worcester, which offers a 24-hour emergency specialist service in co-operation with a consultant vascular surgeon from Hereford.

Plans are in place to extend this service to cover major non-emergency cases over the course of the next six months.

However, most outpatient, pre-operative assessment and aftercare is still provided at hospital sites throughout the two counties.

"There is still much work to be done and the next year will be very busy as the plans for Kidderminster Hospital to become a state-of-the-art ambulatory care centre are further developed", said Ruth Harrison, chief executive of Worcestershire Acute Hospitals NHS Trust.

"The opening of the centre in 2003 will provide a one-stop "walk-in, walk-out" service developed to suit most of the needs of local people - including a primary care centre, state-of-the-art diagnostic facilities, renal dialysis unit, non-emergency surgery, out-patient clinics and a medical day centre."

Mrs Harrison also paid tribute to staff for their support during the time of upheaval.

The transfer of acute and emergency patients to Worcester had originally been planned for 2002 when the new hospital opens - but a shortage of junior doctors and consultants to ensure patient safety at Kidderminster hastened the move.

The emphasis of modern-day health care is to keep as many people as possible out of hospital unless they really need to be there, helping them to cope in their own homes, where most would prefer to be.

With this in mind, Wyre Forest Primary Care Trust (PCT) has set up an intermediate care team, providing short-term nursing and therapy care at home for patients who do not need 24-hour support.

A successful campaign which provided 73 per cent of the district's pensioners with flu jabs also helped towards reducing hospital admissions and the PCT has now appointed a specialist nurse in diabetes to advise and treat people with this increasingly common condition.

For patients who do not require admission to an acute hospital but who still need short-term in-patient care, a 20-bed unit has been set up at Kidderminster Hospital, where they can be looked after by local GPs, nurses and therapists.

The health authority has invested £600,000 a year with Hereford and Worcester Ambulance Service to step up the number of vehicles and staff available to transport patients from the Wyre Forest district.

Fourteen extra paramedics and technicians have been recruited and seven more staff have been appointed to provide a new "high dependancy" service, using two specially-designed vehicles to transport patients who are poorly but who do not need the attention of a trained paramedic.

The health authority has also sponsored a new hospital link bus service from Kidderminster to Redditch and Worcester, which has become popular, with a total of 9,800 journeys made over the year since it started.

Those visiting patients in hospital travel free, with tokens provided at outpatient clinics or from wards - but the two new routes have also attracted 40,000 new fare-paying passengers, giving a boost to the general public transport service.

"The reforms in Worcestershire have been designed to provide the safest and most advanced treatment possible for people from Wyre Forest and indeed from the whole of the county", said Pat Archer-Jones, chief executive of Worcestershire Health Authority.

"Patients still receive the majority of their care locally but we are making sure that, within the county, they have access to specialist staff and modern equipment to treat the widest range of medical conditions".

Despite all the changes over the last year - and the floods which led to the evacuation of Worcester Royal Infirmary's Castle Street branch during the winter - the county's hospitals still achieved Government waiting list targets for the year.

Pat Archer-Jones

chief executive

Downgrading of hospital has been a disaster

THE sad, sad thing about the drastic downgrading of Kidderminster General Hospital is that now, when it is being openly admitted that such changes demand a re-think, Alan Milburn MP has matters of crucial national and international importance on his hands.

These make it difficult for the Secretary of State for Health to consider the plight of people in Worcestershire and surrounding counties.

Make no mistake, the downgrading has been a disaster, as most patients and staff in the remaining acute hospitals in Worcestershire will agree, regardless of what managers, drowning under a flood of their own making, may say.

Complaints have risen according to the Community Health Council.

Staff complaints to the media are rubbished by management but not extinguished.

Long waits in A and E and medical admissions units still occur.

Shortage of beds has been at last admitted by managers - "...reductions (in bed numbers) previously planned as part of the PFI proposals are unlikely to be deliverable in the light of demand for emergency and elective services". (Trust Brief, July 2001).

Men with severe prostate troubles and patients in pain awaiting joint replacements are desperate as they have little hope of relief soon.

Some of the problems facing Wyre Forest and South Shropshire patients include:

Patients from the minor injuries unit are told to go to Worcester carrying their own x-rays. Much-vaunted telemedicine was supposed to stop the transfer of x-rays, let alone patients.

Patients sent to Worcester at night have to pay £32 for a taxi home when found not to need admission.

Elderly people say they are frightened to visit their GP in case they are sent to Worcester - impossibly far away if no car is available.

Wyre Forest waiting lists have deteriorated from previously good levels to unacceptable countywide levels. Comparisons are now impossible following the merger of the acute hospital trusts.

Recent specific cases include:

A patient with chest pain referred to Ronkswood, arrived at mid-day, not seen by a doctor until 10pm then transferred to Newtown and admitted to psychiatric ward where the patient maintains he was only seen by psychiatrists.

A patient admitted at 7.45am for an operation was told to go home at 12.56pm as no bed was available.

A knee replacement patient writing about ward experiences said: "The noise was dreadful, the standard of nursing care very poor when one is so utterly dependent on help. We were kept waiting for bedpans, medication etc, no chance of being offered a bowl at night for a wash or cleaning teeth."

A long and complicated case where the communication to knowledgeable and well-informed relatives about a critically ill patient was felt to be lamentable and allegedly inadequate treatment possibly led to avoidable brain damage in a previously fit patient.

Solutions are still possible to rescue hospital services for the whole county.

Despite the pre-election urgency for the Darzi Report, which was duly handed in on July 31, action has been delayed by ministerial holidays. I have not yet received a meaningful response to a letter to Mr Milburn, stressing the urgency of the situation.

If the report recommends brief in-patient stays it could, for example, shorten the wait for non-emergency waterworks operations. If it supports slightly longer stays, joint replacement operations could become possible here with immediate benefit to waiting lists across the whole county.

Secondly, urgent local action on the Royal College of Physicians and NHS Confederation re-think of the delivery of acute hospital services is essential.

Any logical solutions depend solely on Mr Milburn. No-one else can sanction them even though they are so obviously needed by people and supported by the silent majority of staff.

Dr Richard Taylor

MP for Wyre Forest