Hospital decision time

The status of Stepping Hill Hospital is in doubt following the publication of plans to create a two-tier system of hospitals across Greater Manchester. The reorganisation, entitled Healthier Together, is the subject of a controversial holiday-time consultation lasting until September 30.

The key element in the reorganisation is the upgrading of four or five out of 12 district hospitals to the rank of “Specialist” hospitals where high-risk surgery will be concentrated. The remaining hospitals will no longer carry out emergency operations or general surgery where the patient’s life is in danger but they will still cater for 96% of A&E patients .

Healthier Together has been put together by Greater Manchester’s 12 NHS commissioning groups with central NHS watching over their shoulders. Confusingly, the consultation documents weave together proposals for hospital surgery and a plan for better care in the community.

Although the consultative documents are voluminous they fail to make clear that the Healthier Together changes exclude other specialist hospital services including treatment for heart failure, stroke, trauma, cancer, burns and transplantation. In a debate in Parliament the consultation was condemned as a shambles.

Too many deaths

The two underlying arguments of Healthier Together are that Greater Manchester’s hospitals are not up to standard and that there is no money for expected increases in patients needing hospital care. The consultation documents estimate that below-standard care of dangerously ill patients costs the lives of at least 150 patients a year in Greater Manchester. There is said to be a 50% difference in mortality rates between some hospitals in the region.

Healthier Together identifies the crucial weakness of hospitals as a shortage of consultants, particularly for high-risk surgery. Even if funds could be found to pay more consultants, hospitals would struggle to recruit them because of a national shortage. Recruitment of nurses to work in emergency departments is also difficult.

With high-risk surgery concentrated in just four or five hospitals, the recruitment of extra consultants should be more achievable. Healthier Together also plans “single service” teams rotating medics between specialist and general hospitals; this would make work in general hospitals more attractive for career-minded doctors. The aim is to have consultants present at both tiers of hospitals for more hours a week than at present.

To keep within a 2% cut in hospital budgets, Healthier Together has three main ideas:

1. Stays in hospitals will be shorter – though how this will be achieved for the many frail elderly patients is not clear.

2. Improved primary and community care may slow the increase in patients’ needing hospitalisation. GPs’ surgeries will be opened at weekends with a mission to take greater care of the chronically sick.

3. Some services will be taken out of hospital and into the community.

It is claimed that the net effect across Greater Manchester will be that between 500 and 600 hospital beds can be cut. This reduction has been little publicised, perhaps because people might ask what happens if the forecasts on which it is based turn out to be wrong.

Distant hospitals

While improving care in the community will be widely welcomed, the shift to two tiers of hospitals is worrying on at least two counts: some journeys to hospital will become considerably longer, while hospitals that lose high-risk surgery and intensive care could be starting on a process of decline.

Very sick patients will be taken to top-tier “specialist” hospitals by emergency ambulance, so it will be mainly patients’ visitors who face a possible trek by public transport. However, 20% of “elective” general surgery is also high risk, so it’s possible some of these patients may face a travel challenge.

Healthier Together is considering which one out of three possible top-tier hospitals will cater for dangerously ill Stockport residents: Stepping Hill itself, Wythenshawe or far-off Oldham. Oldham has already been promised top-tier status but neither Wythenshawe nor Stepping Hill may make the cut.

Stepping Hill faces an uphill battle for “specialist” status. Its main rival Wythenshawe is a teaching hospital and already takes heart failure cases from Stockport, while Stepping Hill’s A&E is unable to meet the national target of seeing 95% of its patients within four hours. Stepping Hill also has a troubled relationship with Stockport NHS Clinical Commissioning Group. Its strongest argument for “specialist” status is that it caters for parts of Derbyshire that would have impossibly long travel-to-hospital times to Wythenshawe or Oldham.

Deep within the hundreds of pages of Healthier Together’s consultation documents is an indication of further changes that may await second-tier hospitals: maternity and some children’s services could be moved to top-tier hospitals later.

A consultation questionnaire can be found on Healthier Together’s website.

Author: Graham Trickey, Stockport NHS Watch