Emergency talks

THE fact that no less a figure than Professor Sir George Alberti has cast his eye over plans to reshape hospital services in County Durham and Darlington should be reassuring.

Sir George, who started out as plain old George in his boyhood days in Gateshead before rising to become President of the Royal College of Physicians, is one of the most distinguished doctors in the UK.

More to the point he is the current National Director for Emergency Access and Clinical Director for Service Reconfiguration.

As part of his job, which involves giving advice to the Department of Health, he also vets any proposal to restructure NHS hospital services.

Change is often unwelcome, especially if it means your local hospital is losing services to a larger neighbour, but Sir George says he is not in the business of closing hospitals – but helping to find a new role for them.

Sir George, who spoke to The Northern Echo exclusively from his Lakeland holiday home last week, sums it up succinctly: “My view is you close hospitals over my dead body. What we do is to change their function.”

The detailed plans for County Durham and Darlington NHS Foundation Trust are still under wraps, but it seems to be no secret that the proposals are likely to involve the downgrading of accident and emergency services at the six-year-old Bishop Auckland General Hospital. This is part of a nationwide modernisation of hospital services which is causing ripples of discontent up and down the country.

Sir George, who remains Emeritus Professor of Medicine at Newcastle University, the city where he spent many years as a ‘hands-on’ consultant, has also been involved in looking at proposals to modernise hospital services in the Stockton and Hartlepool area, a process which eventually came up with the ‘nuclear option’ of knocking down two existing hospitals and building a new, ultra-modern replacement on a new site.

There have already been howls of protest from people in Bishop Auckland about the proposed changes, with the town’s MP, Helen Goodman expressing “grave concern” at plans to replace the, admittedly limited, A&E department at Bishop Auckland hospital with a combined minor injuries unit and medical assessment centre.

This would mean that anyone needing emergency treatment after 10pm would have to travel to Darlington Memorial Hospital or the University Hospital of North Durham.

While not revealing the full details of the proposed changes, Sir George believes the people of County Durham should not be unduly alarmed about the changes, which, in his view, will result in more people, not fewer, being treated at the £67m hospital, as it fulfills a new role of being a centre for planned daytime surgery, as well as offering a wider range of outpatient clinics for local people.

“People do worry about their local hospital losing services, but to ensure good quality, safe services we are going to have to focus more acute services on fewer sites,” he says.

Part of the reason for the change is the European Working Time Directive which has slashed the number of hours trainee doctors can spend on duty.

But Sir George says there is a second, far more important reason for change. “The whole atmosphere has changed. As a profession, we have become more honest about what patients deserve. They do not deserve to see a very general doctor when they are ill without an experienced doctor being present.”

Sir George recollects that when he did his hospital training all of the patients would be initially seen by a relatively junior Senior House Officer.

“Thirty years ago, patients were delighted to see any doctor. Now there is much more active management of patients and they need to see experienced people.”

“What we have to look at is whether the situation at a given hospital is safe, is the service of a high enough quality and are we doing the best for our patients?” says Sir George, who points to the success of concentrating acute heart services at specialist regional centres.

“If you take a hospital with a small number of doctors you have to look at whether they can provide a round-theclock service,” he adds. “You really want a centre where experienced clinicians are available 24 hours a day, who can see a patient within one hour of them arriving. That is terribly difficult to do if you have a very small number of consultants.”

In the case of Bishop Auckland, Sir George points out that there is currently not a single consultant employed at the hospital.

“Registrars are the most senior people there and with changing working hours coming in next year, trying to put in a duty rota with doctors who are experienced in dealing with the majority of emergencies is impossible.”

Currently patients in the Bishop Auckland area who are severely injured in accidents or crashes and require emergency surgery are taken by ambulance straight to the Darlington or Durham hospitals which both provide full-service 24/7 emergency services.

Up to now, Bishop Auckland can handle overnight medical emergencies, but difficulties in staffing the intensive care unit means that some very ill patients have to be transferred to Darlington or Durham to get the care they need.

Sir George can understand local people getting jumpy at the idea of potentially life-saving services being moved further away but argues that it is safer in an emergency to be taken to a fully-equipped specialist acute centre with experienced senior doctors rather than to the nearest hospital.

“I can’t find any evidence of patients dying in ambulances because they have had to travel an extra 20 minutes,”

says Sir George.

But the MP for Bishop Auckland, Helen Goodman, will need to hear some very persuasive arguments from NHS officials before she will accept that stripping her local hospital of A&E facilities is a good thing.

In a letter to Lady Ann Calman, chair of County Durham Primary Trust, Ms Goodman writes: “These proposals ignore what people want and the NHS is, after all, paid for by the public. I surveyed my constituents in Bishop Auckland and 93 per cent of them said the most important thing they wanted in their local hospital was an A&E department. There are still too many questions that remain unanswered about these proposals, particularly concerning transport provision to hospitals in Darlington or Durham, staffing numbers and how rural areas will be affected by the loss of this service.”

The MP will be attending the next board meeting of County Durham PCT at the Ramside Hotel, County Durham at 1pm on September 2 to hear more details of the proposed hospital re-organisation, along with Councillor Sam Zair of the town’s Save Our Hospital group, who has been an outspoken critic of the plans. The MP has also called a public meeting at Bishop Auckland town hall at 6pm on September 17 – before the favoured option for restructuring the hospital trust is expected to be announced on September 24.

Sir George accepts that feathers will be ruffled by change but argues that it will result in a safer, more effective health service.

“You have to remember that in the case of the County Durham and Darlington trust, you are serving the whole population of 600,000. We have to consider what services we can safely deliver as close to people’s homes as possible.”

If the changes go ahead, Sir George predicts that Bishop Auckland hospital will have a bright future, performing a slightly different role.

“You will end up treating more patients in that hospital by improving other services and putting on more outpatient clinics,” he says.

■ Outline proposals about changes to hospital provision in County Durham and Darlington are expected to be announced on Tuesday.