Public Agenda Item: 8(b)
Paper for the Public Trust Board Meeting to be held on Tuesday 26 th June 2007
FUTURE OF BRIDLINGTON HOSPITAL PUBLIC CONSULTATION UPDATE REPORT

1 BACKGROUND REFRESH
1.1 - Board members will recall the previous paper presented to the April Board meeting which made the following recommendations regarding acute medicine on the Bridlington site: Following completion of the additional evaluation of cardiology and acute medical services; and the full analysis of the responses regarding acute medical services , the public consultation would return to a Public Board Meeting for decision by the Trust Board by the end of June 2007.
1.2 - Board members will recall that three options were proposed: One was to make no change; The second was to move all acute medical emergencies to Scarborough; The third was to maintain day-time admissions at Bridlington.
1.3 - Bridlington Hospital was visited on 16 May 2007 by Professor Sir George Alberti on behalf of National Clinical Advisory Team at the request of the Trust. Professor Alberti was asked to comment on the suggested scenarios for Bridlington Hospital with particular respect to acute medicine services.
1.4 - The visit began with a round table discussion with representatives of medical services. The four Bridlington-based physicians were present together with one physician from Scarborough, nursing staff, the Chief Executive and administrative staff. This was followed by an opportunity to look round the hospital, visit the medical wards, coronary care unit and admission suite and urgent care centre. This was followed by a wind-up discussion.
1.5 - The Royal College of Physicians (RCP) has also been approached with a view to undertaking an Independent Review of the services that could be safely provided on the Bridlington site and which services could be sustainable.
1.6 - The Royal College of Physicians Independent Review is a costly exercise; it is probable that the College would provide a range of options covering different scenarios rather than giving definitive advice regarding the specific situation within Bridlington. Given the current financial climate within both the Trust and Future of Bridlington Hospital Public Trust Board Mtg 26.06.07 Page 2 of 5 our main commissioning PCT for Bridlington Hospital it is likely that some scenarios would not be affordable or sustainable.
1.7 - Consequently the current view is to hold off from undertaking an RCP Independent Review pending a view from Professor Alberti on a future model of services for Bridlington Hospital.
1.8 - Board members will be aware of growing concerns with the Deanery that Bridlington Hospital cannot provide a satisfactory training experience. In light of this a meeting has also been held with the Yorkshire Deanery regarding the future of Bridlington Hospital in relation to providing medical training for junior doctors.

2 PROFESSOR SIR GEORGE ALBERTI S VIEW
2.1 - In Professor Alberti s view the no change proposal is untenable, on the grounds that there is no acute surgeon on sin site and no laboratory services but even more important there are a grossly inadequate number of consultants or experienced acute physicians to deliver the hands-on care that modern medicine requires around the clock.
2.2 - There is also no formal intensive care provision, and no senior anaesthetist on site 24/7. Transfers if needed would be lengthy and it is by no means certain that appropriate staff would be available for the transfers.
2.3 - Professor Alberti also felt additional factors are that the current number of admissions per day is small and 7 to 8 junior medical staff with the same number of middle grade staff are required to maintain a rota. The situation will be more taxing when the higher EWTD threshold becomes law.
2.4 - Professor Alberti also felt that many of these objections also apply to the daytime admissions proposal. Cover would still be required at night and the lack of support services applies during the day as well as during the night.
2.5 - Interestingly he also felt that the alternative proposal that all acute medicine is focused in Scarborough also had problems but that these are soluble. Professor Alberti recognises that obviously distance of travel concerns both the public and staff. However his view was that paramedics are much more skilled than previously and treatment starts when first contact is made rather than when the patient arrives at hospital.
2.6 - The advent of both community matrons to deal with the elderly and those with long-term conditions and Emergency Care Practitioners should also decrease the number of people requiring transport as emergencies. He makes the point, also widely made by the public that it will be important that the improvements in community services are put in place before any acute medicine moves.

3 PROFESSOR ALBERTI S SUMMARY
3.1 - For Professor Alberti it is obvious that changes in acute medical services at Bridlington are vital on the grounds of safety and quality. The current physicians have done an excellent job but the position is not sustainable. Future of Bridlington Hospital Public Trust Board Mtg 26.06.07 Page 3 of 5
3.2 - Professor Alberti did not feel that the removal of all acute services from Bridlington was necessary or advisable. As was hoped, he strongly recommended a range of actions that would see a range of different services being provided in Bridlington meeting the needs of a significant number of the local population and tailoring the hospital to provide services based on meeting the specific needs of the local population.
3.3 - One proposal was that an emergency clinic (consultant led) should be held every morning - at least 6 days a week at Bridlington. At the same time there should also be an assessment unit for older people open in daylight hours 6 or 7 days per week for GP referrals of those requiring assessment but not necessarily admission. This should staffed by a consultant geriatrician - with rotations from Scarborough.
3.4 - Professor Alberti felt these clinics could be closely coordinated with the Urgent Care Centre which should have GP out of hours services closely integrated. He also suggested that OP clinics should be strengthened in Bridlington.
3.5 - Professor Alberti strongly recommended that the combined consultant physicians need to work together much more closely so that there is appropriate specialist cover and also appropriate provision of non-urgent services in Bridlington.
3.6 - He also felt attention should be paid to the more specialised areas such as primary angioplasty and stroke and decisions made as to where these services should be provided.
3.7 - Professor Alberti has been invited to return to the Trust to meet with all consultant physicians across both Bridlington and Scarborough sites to discuss potential models of service and how specific acute medical services can be retained and developed at Bridlington Hospital. Professor Alberti has also offered to meet with the local Overview & Scrutiny Committees (OSC).

4 DEANERY DISCUSSION
4.1 - Currently the Deanery are supporting Fixed Term Senior Training A***** positions at Bridlington. These posts are by definition fixed term ; it was clear from the meeting with the Deanery on Friday 15 June 2007 that these posts will not be renewed beyond the current fixed term.
4.2 - Given the current level of admissions at 7 to 9 per day; and the range of patients seen at Bridlington, plus the current clinical working arrangements, and feedback from the medical students themselves the Deanery have given a strong and clear message that they cannot continue to support training posts at Bridlington Hospital.
4.3 - In discussion with Deanery staff on how we could move forward to retain training experience at Bridlington they were adamant that the clinical experience and range of services provided at Bridlington needs to change. Fortunately at the point of the meeting with the Deanery we had the benefit of Professor Alberti s preliminary feedback. Future of Bridlington Hospital Public Trust Board Mtg 26.06.07 Page 4 of 5
4.4 - In outlining the broad headlines of the range of specific acute medical services Professor Alberti was proposing at Bridlington the Deanery were willing to support training experience at Bridlington into specific clinical areas as part of a Scarborough Hospital rotation.
4.5 - This position from the Deanery is very encouraging as it will potentially support the Trust in meeting the European Working Time Directive on the Bridlington Hospital site.

5 RECOMMENDATIONS
5.1 - The Board are requested to consider the information presented in this paper and agree the following action plan:
5.2 - Following Professor Alberti s meeting with consultants establish a meeting between Professor Alberti and the North Yorkshire County Council and East Riding of Yorkshire Council OSC representatives.
5.3 - Continue close dialogue with the Yorkshire Deanery to maintain their engagement in ensuring a training presence on the Bridlington site.
5.4 - Establish a definitive plan, in collaboration with Professor Alberti and Trust clinicians, to build a range of acute medical services to stay on the Bridlington Hospital site.
5.5 - The first stage of this plan will commence immediately with a view to establishing a consultant led emergency medical assessment clinic at Bridlington Hospital, building on the Scarborough experience in time for the summer peak tourist season.
5.6 - The second stage will also commence immediately within the current round of job planning for consultants, ensuring the optimum range and level of consultant session commitment to Bridlington is delivered.
5.7 - The third stage will involve planning the delivery of a more intensive rehabilitation service to support a rapid return of some patients to their own locality (Bridlington) following an acute episode in a larger general hospital. This will typically include patients who have had a stroke or had joint replacement surgery. This service should be established within a six month timescale (i.e. before the end of the calendar year).
5.8 - Following further discussion with Professor Alberti the assessment unit for older people open in daylight hours 6 or 7 days per week for GP referrals of those requiring assessment but not necessarily admission, will be established. This facility should staffed by consultants in care of the elderly - with supporting rotations from Scarborough. This service should be established within four months in preparation for the winter period.
5.9 - All future consultant and key clinician appointments will be required to provide sessional commitments on both Bridlington and Scarborough Hospital sites. Future of Bridlington Hospital Public Trust Board Mtg 26.06.07 Page 5 of 5
5.10 -Further plans will be submitted to a future Board meeting following discussion with Professor Alberti and Roger Boyle, the Cardiology Tsar on the range of cardiology services to be offered across the Trust on both Bridlington and Scarborough sites.
5.11 - In terms of providing feedback from the consultation, subject to the board approving the above recommendations The Bridlington Services Plan should be communicated as widely as possible.

I G McInnes
Chief Executive June 2007