AFTER a recent announcement that the accident and emergency department at the Friarage Hospital in Northallerton would be temporarily downgraded to a 24/7 Urgent Treatment Centre, Dr James Dunbar, clinical director for the Friarage Hospital, talks about the issues facing the South Tees Hospitals NHS Foundation Trust

Q: Why were the latest temporary cuts to critical care at the Friarage made so urgently? We understand staff were told they were to mitigate the increasing risk of an emergency evacuation of the site on patient safety grounds?

Our workforce issues and the difficulties of recruiting anaesthetists have been building over the last 18 months. We have worked hard to recruit and fill the gaps, but at the end of March, one of our remaining senior consultant anaesthetists leaves, which means that we will reach a critical point with only one consultant (rather than four) covering critical care and only two consultants (rather than eight) covering critical care out of hours. If we hadn’t made this planned move, then the Friarage would become unsafe at a future point, increasing the risk of an emergency patient evacuation, putting patients at risk.

Q: If both the ITU department and the Allerton Ward are closing, what will be left at the Friarage and how many staff will there be?

The vast majority of the services at the Friarage remain unchanged with nearly nine out of ten patients unaffected, with planned day surgery, outpatient clinics and treatment of minor illnesses and minor injuries continuing. The majority of patients who attend A&E at the Friarage now will still be treated under an Urgent Treatment Centre model. We will also now be able to treat children with minor illnesses (such as fever, rashes, asthma), rather than just minor injuries, which has been the case in recent years.

There are approximately 9,000 staff working at both the Friarage Hospital and at James Cook University Hospital, as well as in the community. No staff will be affected by the urgent temporary change from A&E. There are currently 21 nursing and support staff working in critical care who are affected by the changes and we expect that they will move to James Cook, providing the critical care service they do now or to other roles at the Friarage.

The changes to surgical critical care mean that 36 nursing and support staff are potentially affected. However, we expect day care surgery to increase, requiring more staff and we are meeting with all staff to discuss their preferences.

All current medical wards remain open, however the way we use the beds on wards will change as we increase more day case surgery.

Q: What is the difference between A&E and an Urgent Treatment Centre?

The majority of patients that we currently see at A&E in the Friarage will still be treated under an Urgent Treatment Centre. This includes patients with minor illnesses or injuries such as suspected broken limbs, strains, sprains, minor burns, ear, throat or skin infections, eye problems, abdominal pain, vomiting, fevers, coughs and colds.

Q: Staff have told us that the trust employs up to 80 anaesthetists and 24 A&E consultants, why can’t these staff be rotated to keep cover going at the Friarage?

We have a shortage of specialist staff to support critical care, which includes anaesthetists, and there is a shortage at James Cook as well as the Friarage Hospital. These numbers of consultants include large numbers of part time staff and a number who don’t work for the trust (as some work for the military). Regional trauma centres and large teaching hospitals like James Cook employ consultants with very specialist skills and whilst a number have been working at the Friarage to cover the workforce gaps, the Friarage needs doctors with broader expertise, which not all consultants have.

The workforce problems we have in recruiting anaesthetists are local, regional and national. Nationally, only 42 per cent of training spaces are filled for anaesthetists. Locally, there are fewer doctors with generalist skills, as training becomes more specialised, resulting in fewer doctors available with the necessary skills to work at smaller hospitals, like the Friarage.

Q: Last year an extensive public engagement exercise was carried out by the trust, what happened to that and are you planning a consultation even though you are making these changes.

During the recent public engagement on the future of the Friarage Hospital, we committed to developing a safe and sustainable future for the hospital and this absolutely remains our intent. Once we have stablised our current services, we will be working in partnership with the CCG to deliver a full public consultation in order to agree the longer term sustainable future service model for the Friarage, something that we all want to see.

Q: These have been described as temporary changes, but some people feel that they are really a fait accompli? Some people who believe this is another thin end of the wedge for their beloved hospital and eventually the Friarage will become a clinic and not a district hospital?

These are temporary changes, as any permanent changes require a public consultation. However, there is still an underlying workforce problem, with the national shortage of anaesthetists and intensive care consultants, which is a longer-term problem.

We have been working over the last 18 months to develop a consensus amongst clinicians on how we deliver an innovative but sustainable model for the Friarage Hospital that minimises unnecessary patient movement and maintains local access.

We believe that we can deliver this for the Friarage, which will be innovative, ambitious and importantly sustainable and we have had independent review from the clinical senate who agreed that the current services at the Friarage were not sustainable and that the model we were proposing is not only innovative by importantly sustainable. The changes we now urgently making are in line with this model and will be part of the consultation on the future of the Friarage.

The recent opening of the £10m Sir Robert Ogden Macmillan Centre is the latest investment in the Friarage Hospital, following previous investments in the MRI scanner, in equipment for endoscopy, orthopaedics and radiology, as well as redeveloping the ward blocks and a £3.5m energy centre and part of our long term commitment to the Friarage Hospital.

Q: How can people in rural areas such as Hawes and Masham believe that they will be able to get prompt treatment in emergencies when they have so much further to travel?

As is the case now, the majority of unwell patients will still be able to access excellent care in the Friarage and we are working with Yorkshire Ambulance Service to ensure this continues.

Those who require critical care will be taken to James Cook, which is where patients who have serious illnesses or major trauma, such as stroke, head or spinal injuries are already treated.

Q: Will the changes put lives at risk, and mean a reduced service?

We are making these changes to provide safe services for the population we serve. There are robust plans in place to ensure patient safety and the vast majority of the services at the Friarage Hospital will remain unchanged with 89 per cent unaffected by these changes.

Part of the changes we are making will mean that a medical consultant will review all emergency cases, prior to arrival via a telephone triage, with the ambulance or GP and divert more seriously ill patients to appropriate hospital sites, typically James Cook or Darlington Memorial. This decision will be based on patient need and the patient’s home location.

Where appropriate, we will return patients to the Friarage once their condition has improved, for the remainder of their hospital stay.

Q: Is this change about saving money?

These changes are being made because of concern about patient safety. The changes will actually cost money, introducing additional cost pressures in the region of £1.7m for the trust. This investment will help us to provide a sustainable future for the Friarage Hospital which is what we’re committed to providing.