THE captains of the NHS in Worcestershire seem to have steered their beleaguered ship out of treacherous waters only to land her squarely in the doldrums.

It is hard to remember a time of greater uncertainty in the 64-year history of the National Health Service than we are experiencing right now. Locally, leaders continue to stall over a shortlist of options which will change the shape of our health service, deciding what kind of care is provided at each of the county’s three main hospitals – Worcestershire Royal Hospital in Worcester, the Alexandra Hospital in Redditch and Kidderminster Hospital. Last week bosses said they were committed to providing care at all three hospitals, reassurance at least that there are no immediate plans to close any one of them down – what the local Unison representative has described as “the nuclear option”. But, beyond that, little, if anything, is certain.

We will have to wait until January next year, at the very earliest, to see what options are on the table as part of the joint services review (JSR). The JSR was launched to address a demand for health services which is rising faster than the cash available to pay for it, a consequence of a growing population living longer with complex and serious health needs and the increasing cost of new drugs, treatments and technologies.

January marks the anniversary of the launch of the controversial JSR, which seeks to find ways of saving £50 million over the next three years from our hospitals, only a share of the £200 million which must be saved across the county’s NHS as a whole.

Despite much talk behind the scenes involving clinicians, patient representatives and managers you could be forgiven for thinking we’re almost as much in the dark as we were when the JSR was launched in January.

In fact, if you go back to the original documents from the launch, formal consultation was due to take place between July and September this year, after the publication of the shortlist. Come January, we will be four months behind schedule.

But this delay may not be a bad thing. It means the clinicians leading the review are listening to the public and patients and don’t want to rush into plans which undermine care in the county.

Surely it is better to take time to draw up the right options than it is to rush headlong in the wrong direction to satisfy a deadline. The snag is staff morale – uncertainty around hospitals makes it harder to hang onto your existing staff, let alone recruit new blood.

Dr Richard Taylor, the former Wyre Forest MP and hospital consultant, knows all about badly conducted consultations following his experience campaigning against the downgrading of Kidderminster Hospital, which lost its A&E in 2000. He believes these talks have been very different and that the NHS is listening to people this time.

Mind, the review ought to be good considering NHS Worcestershire has set aside two per cent of its annual budget – £1.3 million – to cover the cost.

The main concern throughout has been that the Alexandra Hospital in Redditch will lose its A&E and maternity services which would be centralised at the newer, PFI (private finance initiative) hospital in Worcester which opened more than a decade ago.

Some have interpreted the statement last week by Eamonn Kelly, chief executive of NHS Worcestershire, that the focus on delivering care at “all three hospitals” means there is hope for the Alex. One newspaper locally even viewed the statement as something of a U-turn by health bosses – hope at last that the Alex could keep its A&E and maternity services. But, significantly, no one leading the review has specified which services will be based at all three hospitals and Mr Kelly said the Alex was most likely to be affected by any changes.

Conspicuously absent in his statement is any mention of A&E and maternity services. The statement is almost shrewd in its vagueness. It seems to be saying the Alexandra Hospital could keep these services, soothing anger in the north of the county. But if these services may be saved it also follows that they may not.

When I asked Francis Thomas, head of communications for the JSR, for more clarification on the issue he said he could not rule out the closure of the A&E and maternity services at the Alex.

Neal Stote, chairman of the Save the Alex campaign, which got more than 54,000 signatures against downgrading services at the Redditch hospital, cautiously welcomed the announcement last Thursday but felt it led to more questions than answers.

He said: “We remain concerned about the impact a further delay will have on staff morale and attempts to retain and recruit staff, as by the time shortlisted options are released, services will have been under threat for six months.”

Steve Akers, Unison regional organiser, said: “While Unison welcomes that NHS Worcestershire has not gone for the ‘nuclear option’ of closing one of the three hospitals in Worcestershire, we remain concerned about possible cuts to frontline services at the Alexandra and give our full support to the campaign to maintain a full 24-hour consultant-led A&E and consultantled paediatric, and obstetric and maternity services at the Alex.

“From the start of this process, we have predicted that it would be the Alex that was most likely to be affected and that is now confirmed.

A reduction from a full consultantled 24/7 A&E and a reduction from a full obstetric service is on the cards, but we acknowledge that the acute trust and JSR have not drawn up a final proposal to go out to public consultation on as yet.”

Union bosses are now hoping to meet health and JSR leaders to thrash out ideas about how services could be retained.

Mr Akers said: “Unison will continue to press the Government to end its unsustainable demand for £20 billion of so called “efficiency”

savings from the NHS by 2015, which is partially why Worcestershire Acute Hospitals NHS Trust is in this deep hole financially.”

However, on the bright side, It is possible this latest re-oranisation of the NHS, assuming it leads to centralisation, could solve problems rather than create them. For example, a single A&E department would allow better consultant cover in emergencies, including at weekends. It may also help in the recruitment of middle grade doctors, of which there is a notable shortage.