| Answers to some Questions from NHS Trust | |
Q - How long did Prof. Alberti spend on the Bridlington site to assess its capability ? Prof Alberti has made three visits to the Trust; on two occasions he has been to Bridlington. He has met with both the Bridlington consultants separately, (without a management presence), and with all the Trust's medical consultants, (again without a management presence). He has also spent time in discussion with Overview & Scrutiny Committee members and has met with representatives from PAGER. In addition he has spent time researching the position of similar Trusts and hospitals delivering care to medical patients in rural areas. Q - How long did the Royal College assessor spend site on the BDH ? I don't know as the Royal College visit pre dates my time with the Trust. They typically spend time pre visit in looking at data and information; following that with a visit of about three days, then spend time producing a report. Q - What about recent research that shows increased likelihood of death with extended ambulance trips to hospital? We do consider recent research and try to balance often conflicting research. If the particular research you are referring to is the recently published study on time taken for critically ill patients to reach hospital then you need to realise this research relates to a study period of at least five years ago. Q - What do you propose to do on the several days of the year when the roads between Bridlington and Scarborough are closed due to bad weather ? We will do what we always do in these circumstances and work with other services to deliver the best care that we can. Whilst we can plan for the inevitable inclement weather none of us can foresee on what days it will happen Q - Previously you have stated that Bridlington CMU is unsafe. What is your evidence for this ? The 2003 College report found it to be completely safe. SGH & BDH cardiac monitoring units operate along very similar lines and see a similar number of patients. The BDH figures for 'door to needle' time are better than Scarborough . Are you saying therefore that the Scarborough CMU is unsafe ?? The advice we have been given is that in its current configuration almost unselected acute medical admissions to Bridlington and CMU care at Bridlington are not sustainable . Royal College guidance states that any hospital providing acute medical care should have access to 24 hour anaesthetic support; 24 hour access to surgical opinion and support; and a range of on site diagnostic and laboratory testing facilities including access to scanning. Bridlington Hospital does not have access to 24 hour anaesthetic and surgical support; nor on site access to CT scanning. Scarborough & Bridlington CMU's operate differently in some areas; we are no longer measured on “door to needle” times but are now measured on “call to needle” times. The Scarborough CMU and acute medical admissions are sustainable as Scarborough Hospital does have access to 24 hour anaesthetic and surgical support; and on site access to CT scanning. Q - This is purely about cost saving isn't it ? What costings have you done about inpatient care in Bridlington compared with inpatient care at Scarborough . Why are these costings not within the public domain ? To relocate all admissions to Scarborough would cost the ambulance service 1.2 million pounds, surely it would be cheaper for the health economy as a whole to make the Bridlington service viable. Costing is largely irrelevant in that we receive the same income (NHS Tariff) for each episode of care and/or treatment the Trust provides whether at Bridlington or Scarborough Hospital sites . The more patients we see and treat the more income we receive; the number and range of patients we can treat at each site varies so the income for each Hospital site differs. The NHS Tariff is available on the DoH website; you will see from the information that each procedure or treatment has a standard national tariff paid to every English hospital for the care it provides. I have stated previously that we are working with YAS and East Riding PCT to assess and agree the cost of the potential relocation of acute medical admissions and CMU services to Scarborough . I have also stated that once the cost is assessed and agreed we will look with the PCT at the best use of investing that level of cost – this will include looking at using the money differently to invest more in making services sustainable at Bridlington. Q - If you move the medical wards out of Bridlington you risk losing work from the Driffield areain particular as their work is likely to be referred to Hull.How much will this cost ? If the potential relocation of acute medical admissions and CMU services to Scarborough goes ahead we will not move all medical wards from Bridlington. We will maintain a level of medical services at Bridlington that can be accessed by Driffield patients. We may lose some emergency acute medical work; this would be a loss of income to the Trust. Q - Satelite dialysis unit due to open at BDH. The SGH satelite unit frequently has to ask the SGH doctors for help with patients. Who is going to provide that service at Bridlington ? The Renal Dialysis Unit at Bridlington will be provided by the independent sector; we are currently discussing with them the support they would like us to provide; unlike the current Hull & East Yorkshire Hospitals NHS Trust service they do not wish us to provide medical support. Q - What steps have you taken to ensure there is adequate capacity at SGH for Bridlington patients (currently 2 medical wards and 5 bedded CMU/HDU facility at BDH) ? Presumably you would need to upgrade and convert existing and poor facilities at SGH, howmuch isthis goingto cost ? Surely it would be cheaper to leave inpatients inthe current Bridlington wards which are modern and fit for purpose. There will need to be an increase in beds at Scarborough in CMU and in acute medical admissions; early plans if the potential relocation of acute medical admissions and CMU services to Scarborough goes ahead indicate we could increase CMU capacity and would transfer staff to provide the extra nursing support; similarly we could upgrade existing facilities at Scarborough (capital cost circa 250k. As stated above we will not move all medical wards from Bridlington - we will maintain a level of medical services at Bridlington. The costs of potential relocation are balanced against the investment needed to make the services at Bridlington sustainable. Q - Are you aware that the last week of September, 3 patents due to have pacemaker implants at SGH were cancelled due to lack of bed capacity across the Trust; and yet you seriously propose to reduce bed capacity further - this is before the onset of the flu season. We always have had and always will have occasions when our bed capacity is stretched; this happens across England especially in times of pressure such as the winter and periods when we have outbreaks of flu or gastric infections. Our bed capacity is set by the level of activity PCTs commission we need to work with health partners to make sure we all use our resources wisely especially at times when we are stretched. We have agreed escalation plans that are implemented when these problems occur. Q - Are you going to provide transport links for Bridlington relatives to get to see patients in Scarborough ? If not, why not ? How much would this cost ? We are considering this as a general point; visitor transport is a concern for many patients and their families and friends. We again need to work with others, including the local councils who have responsibility for public transport. One option that has been used successfully elsewhere is volunteer drivers; we are also looking at working closely with community groups in extending some of their transport services. ( Lincolnshire has a very successful Toch H scheme that supports health transport in a very rural county) Q - How much would it cost to make the BDH unit sustainable ? How much would it cost to move the whole service to Scarborough ? If you can't tell us, why haven't you done any costings ? Broad brush figures have been assessed; to provide the consultant anaesthetic and surgical cover alone would be in excess of £1m; in addition we would have the capital costs of scanning equipment (either leased or purchased) plus the cost of radiography staff. Given the deanery's position on training posts we would also need to employ more staff grade Doctors Q - The current service can be made sustainable very easily. It is highly valued by the local community. What is your excuse for taking it off us ? Even though the ambulance crews can give thrombolysis, patients will still need a bed. The largest group of patients don't meet the criteria for thrombolysis but are seriously ill with other types of heart attacks ( i.e. NSTEMI ). These patients need to be looked after on a Cardiac Monitoring Unit and SGH alone will not have the capacity to take Bridlington patients as well. Cardiac patients do not need an anaesthetist. This is a 'fobbing off'. Acute medical patients who deteriorateneed anaesthetic escort amount to about 12 per year and many need to go to a bigger unit at SGH. Professor Alberti's second visit report - We would like a copy of this ! The current service at Bridlington cannot “be made sustainable very easily” to meet the national standards and national guidance. Significant investment is required to meet all the standards and guidance; as stated above we will consider what an alternative investment to the YAS investment would give us on the Bridlington site. This will obviously need commissioner support from ERYPCT. Professor Alberti has not produced a formal report from his latest visit to us. The feedback from his visit will be submitted to a Public Board meeting in due course when the Board receive the proposal for the Future role of Bridlington Hospital . As state previously this is likely to be the December board meeting. Regards | |