Question put to Chief Executive Iain McInnes - We now have the Answers

From: Iain McInnes
Chief Executive Scarborough & North East Yorkshire NHS Trust

Dear Mick

Thank you for your patience; I have attempted to answer each of the points raised in your email below.

Question “Please note your reply Iain to my questions;  it says that Professor Alberti has not made a formal report! Why not! He is pushing ahead with no formal report!  This should be looked into immediately 11/11/07
I am in possession of a letter received from the Department of Health signed by Paul Larkin which was sent to the Rt. Hon. Alan Johnson MP (Health Sec) which clearly states; Professor Alberti first visited Bridlington Hospital in May 07 and then later in July.......It States that Professor Alberti published a report? a claim you deny?”
Answers Iain McInnes As I have stated previously Professor Sir George Alberti has visited the Trust on three occasions. A further visit has been scheduled for later this month. Following his first visit, on 16 May 2007, he produced a formal report which was incorporated into the paper entitled “Future of Bridlington Hospital Public Consultation Update Report” submitted to the Board at its June meeting. I attach a copy for ease of reference. At his subsequent visits he met with a range of staff and stakeholders and gave verbal feedback to those groups on his visits.

Question “When consultations were made and attended by myself and the town there were 4 option on the table for the CMU At the meeting in December 07 a 5 option was presented, the one the Trust is standing by....the 5 option was not included in the consultation?  Do we take it you have moved the goal posts?”
Answers Iain McInnes At a Trust Board meeting following closure of the public consultation, the board agreed that the Trust should look to see if there were any other alternative models of acute medical service delivery that could be provided at Bridlington Hospital . As part of this process it was agreed that external advice should be sought from the National Czar as he was viewed as someone who would know of other models nationally. Hence, Professor Sir George Alberti visited the Trust. From this visit and subsequent discussions with others a hybrid Option Five was developed and presented to the Board at its December 2007 meeting. Option five has not “moved the goal posts” it has established a hybrid model between the options of complete removal of medical services and retention of all medical services.

Question “I can inform the Scarborough NHS Trust run by Chief Executive Iain McInnes that our intentions are to form a Legal team to investigate any deaths in the event of patients dying in the backs of Ambulances through the CMU been removed to Scarborough this will consist of legal solicitors, advocacy's and claims for medical negligence, you have been informed that many lives have been saved in the past with the CMU been sited in Bridlington, we feel that you should be held responsible for any loss of life.”
Answers Iain McInnes I note your comments regarding patient deaths and can assure you that I personally, and the board consider all risks very seriously, as do our colleagues in Yorkshire Ambulance Service and the East Riding of Yorkshire PCT.

Question “Your recent claims that our group are "unhelpful" reported in the Yorkshire Post are without foundation......The reason you state this is you would like the CMU & Acute removed without a challenge, the town of Bridlington do not need to be fearful of our group in fact we have the full towns overwhelming support with a petition which now stands at 16,000 plus with still 2 weeks plus to run....made up of towns people not holiday makers; your claimed the last Petition of 22,500 which was presented to you in December 2006,  A recent March/Protest of 3,000 towns people was a great success but un-attended by the Trust?”
Answers Iain McInnes I, and the Trust board, are acutely aware of the challenges we face in terms of making the proposed changes to services at Bridlington Hospital . We are absolutely clear on the views of local people and the strength of local people. As I have stated previously it is very positive to know that local people are deeply committed to their local hospital.  We have a responsibility, with the Primary Care Trust, to make sure we provide services that are sustainable safe, and meet national standards and guidance.

Question “The Doctors in Bridlington & surrounding areas some 20+ also find the removal of the CMU a very bad move by the Trust and stated the removal of the CMU will result in the loss of life, so the Trust will be holding meetings with the Doctors to see if they can persuade the doctors to toe the line, what are the Trust afraid of??”
Answers Iain McInnes I have met briefly with one of the senior GPs from Bridlington; Bridlington GPs are represented on the High Level Project Board that is working through the more detailed planning for the service changes. I and Trust and PCT officers have met collectively with the GPs at a recent meeting – not to persuade them to “toe the line” but to explain the rationale for the proposals and seek their views. As a result of this meeting, at their request, we have arranged for the local GPs to meet with Professor Sir George Alberti.

Question “To say the Cardiac Monitoring Unit is not sustainable is frankly ludicrous it as worked perfectly for a large number of years and continued to save many lives including my own I firmly believe; 100's more towns residents have stated the same, you stand alone in your fight to remove the CMU......the quote not sustainable is the complete lack of investment which the Trust has done for the last few years........we firmly believe that your next move will be to use the "Health & Safety Rule" you so frequently use to obtain your own way, we only have to take a look at the Minor Injuries Unit you closed through lack of staff over 17 months ago; you then stated you would reopen on 2 occasion; you did staff and no recruitment.”
Answers Iain McInnes There have been many advances in health care in recent years and this means changes in the way we deliver services and the range of support and diagnostic services that are needed to meet national standards; what were sustainable services some years ago are not necessarily sustainable now. We continue to work with the PCT to integrate the Minor Injuries Service with the Out of Hours service so maintaining 24 hour access to unscheduled care.

Question “Highly Trained Nurses on the CMU are talking of leaving because you and you alone have used scare mongering tactics, the talk of removing the CMU to Scarborough does not give nurses a job prospect for the future or security, these dedicated nurses deserve better. “
Answers Iain McInnes Neither I, nor the Trust, have used “scaremongering tactics” leading staff to leave the service. I personally, and the Trust collectively have re-iterated that we will work with all the nursing staff, particularly those who are highly trained in specific areas to ensure that we do not lose those skills.  We are currently out to appointment for Cardiac Nurses to work across both the Bridlington and Scarborough sites in a more integrated way ensuring greater job security for all.  We will need the cardiac nurses from Bridlington to work in Scarborough when the services change; we will also need some of the experienced nurses to provide an out patient and support service in Bridlington.

Question “You Mr. McInnes we believe are playing God with peoples lives; on the other side I see Lynn Young as been brought in to oversee the restructuring of the Acute and CMU and you seem to have convinced her the changes are for a better service; or is Lynn a scape-goat? if the proverbial hits the fan?”
Answers Iain McInnes I do not see myself as “playing God with people's lives”. You appear to have a belief that if I went away so would all the service changes for Bridlington Hospital – that is not the case; it is not my personal agenda. You are well aware that the future of services at Bridlington Hospital has been discussed several times before, certainly as recently as 2002 and 2004 to my certain knowledge. Lynn Young has been brought in to undertake the necessary detailed project and planning work to make the service change happen.  Lynn has a wide range of knowledge and experience; she has her own views and is committed to building a secure future for Bridlington Hospital to ensure we have a hospital in Bridlington for many years to come; Lynn will most certainly not be a scapegoat.

Question “I seemed to baffled by the saying; there is no ICU no accident & emergency and no 24hr anaesthetic cover at Bridlington; noone as ever stated this and you don't need such cover for the CMU?”
Answers Iain McInnes Isolated medical units such as Bridlington are not sustainable without the support of on site access to 24 hour surgical cover and 24 hour anaesthetic cover.  This is stated in national guidance and national standards and has been the recommendation of Medical Colleges of Doctors for some years.   

Question “The statement; the shake-up of services as the full support of the Emergency czar Pro Alberti.....of course it does he was brought in for the sole reason of giving you the extra elbow you needed; then you can say it was Professor Aberti that moved the CMU & Acute not you, yes we've all fallen in now.  "But who invited him" we are at a loss, was it you Mr. McInnes or did he just show up and put his plan together, what a clever man!”
Answers Iain McInnes As stated above, at the Trust Board meeting following closure of the public consultation, the board agreed that the Trust should look to see if there were any other alternative models of acute medical service delivery that could be provided at Bridlington Hospital . As part of this process it was agreed that external advice should be sought from the National Czar as he was viewed as someone who would know of other models nationally. Hence, Professor Sir George Alberti visited the Trust. The Trust board are absolutely clear that, based on national standards and guidance, and in the interests of providing a sustainable safe service at Bridlington Hospital the clinical changes are necessary.  It is a Trust board decision, supported by Professor Sir George Alberti (and other clinicians) – no one is “hiding behind” Professor Sir George Alberti.

QuestionA question the is baffling everone; how do you plan to take 6 beds from the CMU in Bridlington and put them into Scarborough ?  We are informed you have not the room?  If your CCU is full where will heart attack patients end the undertakers or taken miles away from there families and loved one's......rumour as it that you are to have a port-a-cabin attached to take the over-flow?  cost...£1m to £2m can you through some light on this.”
Answers Iain McInnes In order to diagnose, treat and care for patients who are currently treated in Bridlington we will need more beds in Scarborough . This is part of the detailed planning that Lynn Young is doing; the exact bed numbers are being worked on. We will require both Cardiac beds and acute medical beds. One option for providing extra medical beds that is currently being considered is the use of a modular building that will give us modern, well organised, hygienic accommodation relatively quickly.  Hull Royal Infirmary have a similar building at the front of the Hospital which has provided an excellent ward facility for the last five years.  The cost appraisal is also being undertaken as there are different options based on purchasing or leasing the accommodation.

Question “The Yorkshire Ambulance Service (YAS) we are told will need a further 3 Ambulances to cope; 2 Commissioned Ambulances & 1 Rapid Responce Car plus crews & staff...cost £1.5m if the CMU is removed from Bridlington.  At present the YAS is finding it extremely difficult to cope with demand, but of course this will not effect you.”
Answers Iain McInnes Yorkshire Ambulance Service have agreed with the East Riding of Yorkshire PCT to provide additional paramedic crewed emergency vehicles so that the ambulance service can cope with the planned changes. I understand this will provide an additional 24 hours of emergency ambulance cover, requiring three crews. The East Riding of Yorkshire PCT are providing extra funding this service; I believe the cost is around £750,000.

Question “Could you also tell me the difference between Cardiac Monitoring Unit and a Cardiac Care Unit?  Quoted by Lynn Young”
Answers Iain McInnes A cardiac monitoring unit “monitors” a patients condition, providing care and treatment for patients. A Cardiac Care Unit equally monitors a patients condition and provides care and treatment but is able to provide a higher level of treatment because it has access to a larger range of support services including 24 hour anaesthetic cover as well as rapid diagnostic testing..

Question “I noticed you said on a recent interview with the BBC there is no freeze on jobs and overtime is open.....when did this take place because your ban on overtime and recruitment was in place for most of 2007”
Answers Iain McInnes There was no blanket ban on overtime; nor a vacancy freeze in place for 2007. Requests for overtime or agency staffing, and requests to replace staff have been, and continue to be, regularly submitted through the Trust management. Each request is considered , additional information sought as necessary, and a decision made, with clinical input on whether to recruit or not.

Question “The points you made about staffing; nurses at Bridlington in most wards are inadiquatly staffed leading to the latest statements been made..... Where are all the nurses posts you require been advertised, also clearners & porters?”
Answers Iain McInnes We recently completed a ward staffing survey and workload analysis for all clinical areas across the Trust, including Bridlington Hospital . This did reveal some areas of staff shortages to which the Trust has recently been recruiting. Specifically for Bridlington Hospital we have appointed two porters, one of whom is already in post.  Interviews also took place for six qualified nursing staff; three specialist cardiac nurses and four Cadet Healthcare Assistants. Successful applicants are currently being allocated to specific ward areas with commencement dates being agreed. Domestic and catering staff posts are currently being considered.

Question “Remarks were made in the Yorkshire Post newspaper about our group been "unhelpful" I fail to see what this remark means?  Quoted again by Lynn Young; our fight is for fairness for Bridlington hospital so patients receive the correct care and attention, something they are lacking with the recent staff shortages.”
Answers Iain McInnes There is a common perception in the Bridlington area that Bridlington Hospital is closing; we both know that it is not closing in fact whilst we are planning to move six cardiac beds we are also opening twelve dialysis stations. We, like you, are keen to ensure the public and our patients get a clear message; that clear message has to be about exactly what is changing at Bridlington not about closing Bridlington Hospital . We are currently working on how we can ensure local people know what is happening at Bridlington.

Question “Our latest Petition now stands at 17,000+ with 2 more weeks to run made up of the 44,000 residents living in Bridlington and surrounding ares, (not Holiday makers as you once qutoed) who are disgusted with the Trusts agenda to remove the CMU and Acute Medical services. The Petition in its full glory will be delivered to Downing Street & Parliament in March 08, arrangements have been made with Downing street , lunacy you propose by removing the above as got peoples back up.”
Answers Iain McInnes Assuming we receive a copy of the petition, we will assess the petition and its impact in terms of local feeling. As part of this we usually work through the petition and identify where those signing the petition live. This helps us to confirm where our potential patients come from, and also areas where we may work with GPs to increase the numbers of patients that may come to Bridlington hospital for appropriate care and treatment. We also identify how many of the signatures are from holiday makers, especially if the petition has been received during a holiday period.  This is also important as we do have a duty of care to holiday makers who use our services, especially (but not only) minor injuries. I think I have answered/commented on all the points you have raised. I look forward to our continued working together.

Regards Iain McInnes
Chief Executive Scarborough & North East Yorkshire NHS Trust