Triumph for our hospital

HINCHINGBROOKE Hospital, which has been under serious threat of major cuts in services, looks set to be reprieved.

In a dramatic Christmas present to Huntingdonshire patients, the hospital's board yesterday (Tuesday) revealed that it has found a way to streamline the way services are provided. It means Hinchingbrooke could retain a full range of accident and emergency services and, crucially, general surgery.

If it works - and it has the backing of the new, but cash-strapped, Cambridgeshire Primary Care Trust and the almost-as-new East of England Strategic Health Authority - it will be a triumph for medical staff at the hospital, for The Hunts Post campaign to keep vital hospital services in the area and for the 50,000-plus people who signed a cross-party petition organised by Huntingdon Conservative agent, Sir Peter Brown.

Ultimately, it will need the agreement of Cambridgeshire County Council's health scrutiny committee.

But it is also a vindication of the trust board's decision to bring in Jane Herbert as interim chief executive in September to find a way through a desperate financial crisis.

Although Ms Herbert is being cautious at this stage, colleagues are privately jubilant that the downgrading of Hinchingbrooke, which seemed inevitable to many just three months ago, has been averted.

One of Hinchingbrooke's problems, even before huge and mounting debts suddenly emerged last spring, is that it is one of the smallest district general hospitals in the country. With far fewer patients than most, it is difficult to keep its finances in order at the same time as giving patients as good a chance of being cured as they would have in a larger hospital where doctors have more practice in increasingly specialised areas of medicine and surgery.

But, by throwing away traditional demarcations and streamlining the way they will work, doctors, nurses and other healthcare professionals have thrashed out new ways of working together across previous boundaries. The proposals should slash costs without affecting patient care.

General surgery is a vital component in keeping as full a range of services at the 23-year-old hospital as possible. A&E cannot operate in any meaningful sense without experienced surgeons on hand to operate at the drop of a hat. Physicians need the reassurance that surgical teams are available if their patients develop complications. And intensive nursing is a vital component of successful outcomes for the most serious medical and surgical cases.

"The option that looks most favourable at this stage would allow us to can continue to provide full A&E services and a full surgical service with almost no noticeable effects for patients, though there would be changes behind the scenes," Ms Herbert told The Hunts Post. "The clinicians have done a great job, but there has also been a lot of old-fashioned slog involved."

But the future of maternity services still hangs in the balance. Although the hospital has been able to identify much of the £2.2million-a-year gap between the cost of providing obstetric services and the income Hinchingbrooke gets, more money needs to be saved or more income generated.

But all is certainly not yet lost. It may be that a combination of some sort of partnership arrangement with Peterborough's maternity services and attracting mums from the new settlement at Cambourne to Huntingdon rather than Cambridge could help to secure the future of that, too.

It also emerged yesterday that a £6.5million error Hinchingbrooke made in paying too much money back to Department of Health under the "payment by results" scheme earlier this year was actually an £11million overpayment. Although it does not affect the predicted deficit of £29.9million by next March, getting the money back would make a big inroad into the hospital's debt.

Ms Herbert, with strong backing from the SHA, has put intense pressure on the Government to return the cash.

Indeed, the SHA has moved from bogey-man in the whole affair to a crucial supporter of Ms Herbert's and the Hinchingbrooke board's efforts to fix the year-on-year finances.

Three months ago it was widely seen as looking to downgrade Hinchingbrooke to help solve a financial crisis across the whole of eastern England. It set out three possible options for the future, all of which involved reducing hospital diagnosis and treatment in Huntingdonshire by 20-25 per cent and transferring that work to other parts of the NHS where it could be provided equally effectively, but more cheaply.

The first - an obvious non-runner - was to continue the mixture otherwise as before. The second - the chosen path that now seems to have grown wings - was to streamline. The third - which has proved to look more expensive, as well as damaging local delivery of services - was to ship work out wholesale to Cambridge, Peterborough and elsewhere.

The SHA has clearly been convinced by the strength of local feeling and Huntingdonshire's affection for its hospital, and has recently been batting more effectively for the hospital's future than our cricketers have managed in the Ashes series.

But, even if the new plan can be made to work, the £11.5million-a-year savings it implies must be sustained year on year. And the historic debt must be repaid. The track record to date has been imperfect.

"This trust is always going to need tight financial control," Ms Herbert said. "There's still a long way to go," she stressed.

Huntingdon MP Jonathan Djanogly, who with North West Cambridgeshire MP Shailesh Vara has campaigned strongly for the hospital, said: "If the end result is that we retain a full service at Hinchingbrooke, it's a long way down the road from when people were talking about its closure.

"The important thing now is to keep up the pressure and to participate fully in the consultation."

The hospital will continue to work on details of the three options over the coming weeks to formulate detailed assessments for consultation. There will be particular emphasis on finding a solution to the maternity conundrum.

The SHA and PCT will crawl over Hinchingbrooke's figures to satisfy themselves that the favoured option will deliver safe clinical services that the PCT can afford.

The public will be consulted by the PCT on any major changes to health provision, probably in February and March.

Hospital staff and other healthcare professionals will be consulted separately.

The outcome of the consultation will be reported to the county council's health scrutiny committee, and its views will influence the final decision.

Cambridgeshire PCT will make a final decision, probably in May or June.

* More on Hinchingbrooke's future next week.