Two months on, hospital questions answered

The answers come two months after he and West Worthing MP Peter Bottomley asked these questions on behalf of attendees at the KWASH meeting at the Worthing Pavilion in early August who did not have the opportunity to raise their concerns with the SHA's Candy Morris.

Mr Loughton said: "The public deserve to have their concerns answered by the SHA and it is unacceptable they have had to wait two months for this to happen."

Q and A

Who is responsible at the end of the day for the debt incurred at the hospital? Is this bad management by the chief executive and his staff?

Each NHS organisation has a statutory duty to balance its books. Responsibility for the financial position of an organisation therefore rests with its Board.

Most NHS organisations in Surrey and Sussex had a good record in relation to financial performance. The position in some organisations reflects the fact that they have traditionally relied on short-term solutions to financial problems rather than taking a strategic approach. In some cases we have also seen weaknesses in financial planning and management. In the case of Worthing and Southlands Hospitals NHS Trust, there has been significant improvement over recent months.

The accumulated debt to date is not a critical factor in our planning but what is important is to ensure the Trust is financially stable in the future.

Why hasn't Mr Phoenix been asking questions of the chief executive of Worthing Hospital before the debt became as big as it is?

The Primary Care Trusts that commission services from Worthing Hospital liaise closely with the hospital. The Trust believes that stronger financial leadership is required and therefore appointed Peter Hollingshead as the Interim Finance Director to lead the Trust to recovery, supported by turnaround help.

Why isn't the public informed more of changes within the NHS for example when the Surrey and Sussex Strategic Health Authority ceased to exist from July 1st?

The Government and NHS has communicated these changes through a variety of mediums. Commissioning a patient-led NHS was a national announcement. MPs and local stakeholders were asked for views and commented on the proposals. The former SHA issued press releases at every stage of the decision making process. Full information about the process and conclusions is available from the SHA website.

Why have newly qualified nurses been told they now have no jobs when the hospital needs them as they have paid for their training?

We recognise that this is currently a difficult situation nationally, especially for newly qualified staff, and are currently establishing the exact position locally position to inform decision-making about the way forward.

We are already undertaking work to support the newly qualified, such as ensuring they have access to nurse bank (which supplies nurse to fill gaps in ward staffing rotas) opportunities and /or development work

New appointee Sue Webb (SHA Director of Clinical and Workforce Development) is prioritising this work to ensure local orgs are doing all they can to support the new grads and identify all possible employment opportunities

At SHA level, Sue will also be focussed on improving workforce planning to provide better information and make use of new opportunities such as the electronic staff record for data gathering and therefore planning. It is clear NHS needs a more integrated approach and SHA will be leading work with local orgs to improve in this area.

Why is the hospital heavy with administrative staff at the cost of hands on staff?

You might be interested to know that the NHS spends less on management and administrative costs than comparable businesses in private sector. However, in recognition of public concern about this issue the Government announced that, as a part of commissioning a patient-led NHS there would be a reduction of 15 per cent in management and administrative costs in PCTs and SHAs. This equates to 13m in Surrey and Sussex.

Administrative and clerical staff play a vital role in the smooth running of the hospital as ward clerks, medical secretaries etc and are often the lowest paid. They free up clinicians time to concentrate on patient care.

If the population of Worthing is growing why are we going to get a second rate emergency centre?

It is too early to say what decisions will be made about emergency care across Surrey and Sussex. Whatever decision is finally taken, patients and the public can be assured that the plans will take into account population increases and will give all residents access to high quality care delivered in a wider variety of ways.

Will the local health authority be making decisions as to whether the accident and emergency department closes?

The final decisions will be made by the local NHS, in particular the local PCTs.

Who makes the final decisions regarding any downgrading?

We would not recognise any proposed changes as a "downgrading" but as a move to a better, more effective and more convenient provision of urgent care services. The final decisions will be made by the local NHS, in particular the local PCTs.

Before downgrading the hospital would it not make more sense to put in place a walk in centre now to relieve pressures from the main department?

We would not recognise any proposed changes as a "downgrading" but as a move to a better, more effective and more convenient provision of urgent care services. Any changes of service will be carefully coordinated to ensure new services are in place as previous services change. Urgent care networks including walk-in centres, minor illness/injury centres are being developed.

Will GPs be more available to their patients if accident and emergency closes?

It is too early to say what decisions will be made about emergency care across Surrey and Sussex. However, it is true to say that more services can be delivered more effectively by GP practices and PCTs are exploring the scope for extended GP hours.

How many more ambulances will be made available?

South East Coast Ambulance Service NHS Trust has been involved at all stages of Creating and NHS Fit for the Future discussions and has identified from the outset that any potential reconfiguration of acute services will have an impact on the front line resources required. This is not only in terms of additional double and single manned ambulance crews but also in terms of Emergency Care Practitioners (ECPs) and Critical Care Paramedics (CCPs). ECPs have a focus to provide a first response to 999 callers and using their extended primary care assessment skills to determine more appropriate community based care pathways that better meet the needs of the patient. CCPs have extended trauma and critical care skills to support the most severely injured patients who may have to travel further to a more appropriate critical care and trauma centre of excellence.

South East Coast Ambulance Service NHS Trust are unable to consider the closure of just Worthing Hospital and the impact it will have on its resources without knowing and understanding what the final picture of acute care will look like across the whole of the South East Counties including Kent, Surrey, East Sussex and West Sussex.

Once final and preferred options have been considered and agreed, the Trust will be able to define what resources will be required and where they should be targeted in order to best meet the clinical needs of all patients.

Have any decisions already been make regarding whether St Richards or Worthing Hospitals will be downgraded?

No.

Will maternity services be taken from Worthing Hospital after recently being moved from Southlands?

It is too early to say what decisions will be made about maternity services across Surrey and Sussex. Whatever decision is finally taken, patients and the public can be assured that all residents will have access to high quality care.

How many staff will lose jobs through downgrading?

We would not recognise any proposed changes as a "downgrading" but as a move to a better, more effective and more convenient provision of urgent care services. This review is about changing the ways services are delivered and not simply about reducing the workforce. Front line staff may need to change roles and indeed the outcome of strengthened services closer to home may need more people in some parts of the service.

Will the children's centre be moved from Worthing if it is decided to downgrade the hospital?

It is too early to say what decisions will be made about children's services across Surrey and Sussex. Whatever decision is finally taken, patients and the public can be assured that all residents will have access to high quality care.

Is the NHS Direct service going to be cut?

This is a national service, with an important role which will of course develop according to the needs/demands placed upon it.

Will the intensive care department go if the accident and emergency department is taken away?

It is too early to say what decisions will be made about intensive care services across Surrey and Sussex. Whatever decision is finally taken, patients and the public can be assured that all residents will have access to high quality care. The need for intensive care services in a particular location will depend on the other services available locally.

If the decision is taken to close accident and emergency, how long before that happens?

Currently, we expect the new PCT Boards to approve the options for consultation in November and commence the formal consultation process in December. Assuming the normal three month formal consultation timetable and allowing extra time for Christmas, this consultation would close in March. The final decisions will be taken probably in April or May depending on the outcome of the consultation process. This timetable could be subject to amendment.

This timetable is still to be confirmed. Implementation of any decisions would follow this process.

What arrangements have been put in place for staff needing to travel between the two hospitals?

Details of this will need to be included in any implementation plans.

Will the proposed multi-storey car park planned to replace the existing one still go ahead?

It is too early to say what the impact will be on existing plans.

What arrangements have been made for schoolchildren if taken by ambulance out of area?

South East Coast Ambulance Service NHS Trust already respond to school children across the South East who do not have an A&E Department in the town or village in which they live. Children, like all patients, will be taken to the most appropriate A&E Department if their clinical condition requires it, as happens at the moment.

We welcome the development of Children Centres across the region, who we will be working with to ensure that referrals can be made and accepted by ambulance crews for paediatric patients who have a clinical need that is best met by those services based within primary and community care.

How will other accident and emergency departments cope with Worthing's urgent cases when already stretched?

Any proposals consulted on would see a change in the way care is delivered for many types of patients. Research shows that up to 80% of attendances would be better treated elsewhere. These changes will be implemented across all localities irrespective of the final locations of major A&E centres and will better meet current and projected demand. We would implement plans to ensure any impact on capacity in other locations is taken account of.

The A27 is solid with traffic. How will ambulances get through?

The A27 is indeed a very busy road, as are many of the dual carriageways and motorways in Surrey, Sussex and Kent. Ambulances responding to 999 emergency calls and transporting patients whose clinical needs require as short a travel time as possible will use their regular blue lights and sirens in order to ensure as quick a journey as possible. The A27 is the main east/west transport link across Sussex and is, of course, already used on a daily basis by crews in both East and West Sussex at all times of the day.

The increasing expertise of paramedics enables them to begin treatment as soon as they get to the patient or scene, and will not wait until the vehicle reaches hospital before beginning treatment. In addition, and for very serious accidents, air ambulances may be used.

Is the Littlehampton community hospital still going to be replaced as previously was planned and if so how will this be funded if we can't maintain services at Worthing now?

The delay to the scheme for the development of Arun Community Hospital enables the local NHS to complete its review of services and ensure that maximum benefit for patients is achieved by making the best use of both existing resources and developments in modern medicine.

West Sussex PCT is leading discussion about the service review locally.

Will there be a walk in minor injuries unit at Southlands?

Will we also lose other departments from Worthing and Southlands Hospitals?

Will paramedics take the place of Drs in A&E departments?

We will always need consultants for the most serious injuries/illnesses and to lead departments. However, we are developing new ways of working so that we can get the best from our highly skilled workforce. Emergency Care Practitioners for example, with their greater expertise can deliver life saving care 'at the scene' and then take the patient to specialist centres for continued specialist treatment. This increases survival chances rather than diminishes them.

Paramedics and the emerging new role of Critical Care Practitioners are the only clinical workforce who are trained as specialists in pre and out of hospital immediate life support and care. Their role is welcomed and supported by the medical professions, both in primary and secondary care. The role of junior doctors, consultants and nursing and therapy staff in A&E Departments is completely different to that of Paramedics, ECPs and CCPs. Paramedics could not possibly take the place of doctors in A&E Departments, however, continued joint working with both primary and secondary care clinicians and staff will be essential in developing new pathways and practices which will best meet the clinical needs of all patients with urgent and emergency care needs.

How do the fire services feel as they are part of the major incident plans in Worthing?

The ambulance services work closely with the other emergency services through emergency planning groups. Fire services will be invited to contribute to the debate as a part of the consultation exercise.

How would Worthing cope if, god forbid, there was a major incident?

Until we know what the options are we can't explore issues of capacity and expertise. However the current mutual aid agreements with neighbouring NHS providers would need to be 'beefed up' and put in place across a wider area. The SHA's Emergency Planning Steering Group will be scrutinising all proposed options and providing feedback on the likely impact of each, together with recommendations reducing the risks. Likewise the Sussex Local Resilience Forum will be asked to comment. As this is a multi-agency forum their response will provide input from key emergency responders.

Why has the hospital bus been removed and how cost effective is it to have taxis replacing this service being as it is used hourly to transfer patient's notes between hospitals?

The hospital vehicle service between Worthing and Southlands Hospitals has not been removed and notes are not being transported by taxi. The changes to the vehicle service that have been introduced are that it no longer carries passengers and that its frequency has been reduced from half-hourly to hourly. This means fewer, smaller vehicles are required, resulting in an annual saving to the Trust of 30,000.

When will the new chief executive of the PCT be announced?

John Wilderspin has been announced as Chief Executive of the new West Sussex PCT. The PCT became operational on 1 Oct 2006.

Will Steve Phoenix be the new chief executive of the new PCT?

Steve has been appointed as chief executive of the new West Kent PCT. John Wilderspin has been appointed as Chief Executive of the new West Sussex PCT.

Have all GPs been consulted about changes within the hospital system?

The discussion document was sent to all GP practices to invite GPs comments. In addition there have been a variety of events and activities to engage clinicians including GPs.

If the accident and emergency department disappears from Worthing and a patient calls an ambulance because they have no transport will they be charged for the ambulance?

No.

When will the chief executive Stephen Cass be making any statement regarding the hospital?

Announcements will be made during and at the end of the process. The decisions will be taken by the PCTs.

Who determines what constitutes a serious injury?

Medical professionals, with their specialist knowledge. Royal Colleges provide guidance about the case mix needed for training health professionals.

What plans are there for Southlands Hospitals?

How do doctors and nurses feel about the downgrading and have they had an opportunity to voice their concerns?

We would not recognise any proposed changes as a "downgrading" but as a move to a better, more effective and more convenient provision of urgent care services.

The local NHS has sought the views of health professionals from an early stage of the process and it continues to do so. Of course, they are very proud of their hospitals and it is not surprising that they vigorously debate any changes.

Why have beds and wards already been lost at Worthing Hospital?

The number of NHS beds nationally has fallen in recent years. This is because so many procedures that traditionally required a patient to stay overnight or longer are now done as day cases. Also, people are able to be rehabilitated close to or in their own homes and discharged from hospital earlier than before. So, what has happened in Worthing Hospital reflects national trends. Any recent changes at Worthing reflect current operational necessities and are not a precursor to the changes which we will be consulting on.

What right have those unknown people to close the hospital? Where has the money gone? Who is accountable?

Each NHS organisation has a Board of executive and non-executive directors and accountability for the decisions the organisation make rests with the Board.

If the hospital is downgraded will other services go, for example the eye unit?

Would any walk-in centres be manned by fully trained doctors and if a patient is too ill to be treated, would emergency services transfer them to the nearest A&E?

It is too early to say what decisions will be made about services across Surrey and Sussex. Whatever decision is finally taken, patients and the public can be assured that all residents will have access to high quality care and that whatever model is finally decided it will be led by appropriate professionals and treated in the most appropriate setting.

If a patient required more specialist care then yes, they would be transferred to the most appropriate place, as they are now.

Why, if we are so much in debt at Worthing Hospital, have they continued adding new buildings to a fairly new hospital?

The Worthing & Southlands Hospitals NHS Trust has not added any new buildings to either Worthing or Southlands Hospitals during the period in which it has been in financial deficit. Work on the last new build project began more than two years ago and was carried out to create more space for clinical activity at Worthing Hospital. Current capital investment is limited to replacing clinical equipment that has gone beyond the end of its design life and to the refurbishment of the mortuary, which is essential to comply with health and safety legislation and NHS guidelines.

Who makes decisions on which hospital a patient would be taken to in an emergency?

Having assessed the patient's clinical condition and needs, the clinical staff at the scene of an incident will be the ones who decide which hospital the patient should be taken to. There are protocols agreed within which the crews will work. The general rule of thumb is that the patient will be taken to the nearest Emergency Care Centre or hospital who will best be able to meet the clinical needs of the patient.

Was the Fit for the Future booklet meant to be made available for all the public to read and if so why wasn't it?

Yes, the document was made publicly available. Thousands of copies were distributed across the area to local councils, voluntary groups and patient representatives. It was also placed on websites and made available in public libraries. However, the document was primarily intended to help early discussions with people or groups with a particular interest in health services and those with a role in representing patients and carers. When proposals for change are developed there will be a full public consultation which will be even more widely publicised.

Have you calculated how many people will die if you close our hospital?

The evidence suggests that outcomes are better when specialist services serve larger areas. We accept that a balance needs to be struck between clinical, financial and access advantages and disadvantages and between accessibility and the quality of outcome once a patient reaches the centre. The challenge for the NHS is to use its resources wisely and fairly.

If this is a review of all health services across the area, why have hospitals in Brighton not been considered for downgrading?

Services provided in all hospitals and community settings are being considered in the review, this includes services in Brighton.

Will you change any of the plans in light of the overwhelming public opposition in Worthing?

The views received during the discussion phase will be listened to and provide a very useful contribution to the debate, both in finalising the options and during the formal consultation process. The NHS has a duty however to provide a safe service and use its resources effectively to get the best care for the whole range of health needs within communities. We must consider issues of clinical safety, medical practice and affordability as well as the views expressed by the public. These factors have to be balanced to find the best solution.

What will you be doing to make sure we get our fair share of NHS money '“ as much as they get in the North?

We are aware of some peoples views about how funding is allocated in the NHS; but as has always been the case, this is finally a matter for ministers. The previous SHA, through various means, has raised points about the Market Forces Factor and needs element of the Weighted Capitation Formula (the formula that determines NHS allocations) and that the Advisory Committee on Resource Allocation is looking into this amongst other aspects.

However, the most important fact is that the NHS in Surrey and Sussex already receives 130m above its 'fair share' and overspends significantly against this. The fact that some areas receive greater funding per capita reflects higher levels of deprivation and illness.

If it is decided to close parts of the hospital how much notice will the general public be given?

If there were decisions there would be full clinical, public and patient involvement in how they are implemented in a planned fashion.

Have you ever made the journey from Worthing to Brighton or Portsmouth hospitals? How long did it take you?

NHS staff generally and managers frequently do the journeys described. We know that journey times are important for patients and we are analysing these and other journeys carefully under a variety of conditions. Journey times to specialist centres may be longer in some cases. However, the evidence suggests that outcomes are better when specialist services serve larger areas with a range of good quality, very local centres for the mast majority of patients.

A balance needs to be struck between clinical, financial and access advantages and disadvantages and between accessibility and the quality of outcome once a patient reaches the centre. The challenge for the NHS is to use its resources wisely and fairly.

With all of the terrorist problems we have around this country, how do you propose to cope if a similar incident happens locally in Worthing and surrounding areas?

Such issues will be considered by the SHA Emergency Planning Steering Group when they scrutinise the plans and make recommendations to ensure a resilient response. There are already detailed major incident plans involving networks of hospitals and these will be amended as necessary.

For terrorist activity (eg bombs) the major incident plans would be put in place as agreed with partner agencies within the LRF and mutual aid agreements.

My grandson is an unstable diabetic and relies on the A&E and the children's centre. If he has to go to Brighton, he could die. How will we be able to care for him if you shut these services?

While we would not wish to comment upon an individual case without full knowledge of the case, care plans would include immediate access to specialist help locally when needed. Detailed care plans for patients with complex needs, which detail the pathway for every eventuality, would be developed if any changes are made.

Why are students that have worked hard for 3 years now being told that there are no jobs for them at the hospital? It costs 26,000 per year to train nurses. What plans will be in places for these qualified nurses?

Some areas such are already undertaking creative work to support the newly qualified, such as ensuring they have access to bank opportunities and /or development work