Hinchingbrooke: Hailing the hospital heroes

Yesterday was an important day for healthcare in Huntingdonshire as it marked the start of a consultation that will lay the foundations for the future of Hinchingbrooke Hospital. IAN MacKELLAR examines how the NHS avoided cutting services at the Huntingdon hospital and what patients can expect.

DOCTORS and NHS managers in Huntingdonshire may be set to become heroes for campaigners across the country trying to save small hospitals from closure.

By modern standards, Hinchingbrooke Hospital is too small to have a future as an acute infirmary with full accident and emergency provision, a viable maternity unit and, crucially, general surgery that underpins most major departments.

But healthcare professionals have agreed to spring-clean the stuffy and out-moded restrictive practices that for generations have held back modernisation of the NHS.

And they are showing the way to possible survival for scores of other threatened hospitals across Britain.

Yesterday (Tuesday), NHS bosses unveiled changes that could save £14.5million a year and see Hinchingbrooke retain its full range of services, though with about 25 per cent of patients treated not at Hinchingbrooke but in health centres and doctors' surgeries closer to their homes - or even in their own homes.

Treatment will be cheaper but just as good, NHS chiefs promised, and patients would not need to travel so far or so often.

There will be three months' public consultation on the changes, with a decision to endorse them expected to be taken by the new Cambridgeshire Primary Care Trust on June 27.

When the hospital's managers revealed a rising deficit last spring, with no conceivable prospect of repayment, they triggered public fears Hinchingbrooke would close.

As The Hunts Post pointed out at the time, that was never a possibility, but there was a real chance that the financial crisis could lead to its downgrading.

The revelation that the debt was likely to spiral from £8million last April (it was thought to be £4million at the time) to almost £30million by the end of next month seemed to have sealed its fate.

Chief executive Douglas Pattisson resigned in September over the financial crisis, quickly followed by finance director Phil Richards. Shortly afterwards, it was revealed that £6.5million of the debt was the result of an accounting error - Hinchingbrooke gave the Department of Health money that it should have kept.

This error was later revealed to involve £11million.

Enter Jane Herbert, an experienced health service manager with a clear record of sorting NHS management. It is she who has masterminded the new way of thinking that could become a template that saves more than just Hinchingbrooke.

Key to it was sweeping away restrictive practices in which minor procedures - commonly carried out as part of doctors' training - had to be done in hospital, even though every GP in the land could deal with them in a few minutes in his or her own surgery. Now they will do just that.

Nurses will also do more, and so will suitably-trained doctors' receptionists. And many treatments will be delivered by district nurses in patients' own homes.

NHS chiefs promise that quality will not suffer, patients will benefit from not having to travel so far, and there will be money left over to treat other patients once the books have been balanced.

So everyone gains, they say.

It was the rather dull-sounding "general surgery" that was always going to be the vital ingredient in protecting everything else at Hinchingbrooke, because surgeons must be rapidly available to deal with emergencies in any department.

"If they could not shore up general surgery, they would not have been able to shore up A&E," Chris Banks, chief executive of the new Cambridgeshire PCT, which provides 96 per cent of Hinchingbrooke's NHS income, told The Hunts Post.

But, with surgeons dividing their time between Huntingdon and either Cambridge or Peterborough, they devised a way of providing the six-strong 24/7 consultant rota Hinchingbrooke needed for surgery to survive.

With just 10 per cent of patients seen in A&E requiring the attention of an A&E consultant - and when 16,000 out of the 40,000 patients seen in the department should never have gone there - it was clear that major efficiencies were needed if A&E services were to remain in Huntingdonshire.

That has been achieved by creating a consultant-led clinical decision unit, backed by senior emergency nurses and GPs treating the less serious cases. It also means the 40 per cent of minor emergencies being treated in the community.

"The East of England Strategic Health Authority is really quite excited about this new model," Mr Banks said.

But maternity services, losing £2.2million, were still at risk because not enough babies were being born in Huntingdon. The 2,400 births last year fell well short of the 3,000 needed for a clinically efficient unit.

But to move services to Addenbrooke's and Peterborough, the PCT would have had to spend more money investing in new facilities in the city hospitals. So it has agreed to swallow the deficit - now reduced to £1.1million a year - while Hinchingbrooke attracts those 600 additional expectant mums.

The PCT hopes to bridge the gap by attracting women from places such as Cambourne (maybe 300 a year) and, when it is built, Northstowe. And, with 11,200 new homes destined for Huntingdonshire by 2021, Hinchingbrooke's maternity unit should soon achieve critical mass.

But the trust has another trick up its sleeve - its own community midwives, who will ensure mums are aware of the attractions of Hinchingbrooke's maternity unit.

Saving Hinchingbrooke has been a difficult task, Mr Banks acknowledges. "If we didn't have it, we probably wouldn't build it now," he said. "But we do and we must make it work."

That requires changes from GPs and patients, as well as hospital clinicians. "GPs really are going to work at developing attitudes to unnecessary hospital referrals, so that the hospital is used only for what it's there for. It's well used, but it's not funded at that level."

Patients will have to change their expectations, too.

But the work at Hinchingbrooke could become a blueprint for other threatened hospitals.

"Out of this momentum we could get something that's a great step forward for the smaller hospitals," Mr Banks said.

But he warned: "If we can't keep the changes going, we still end up with an unaffordable solution. But the GPs are very engaged and the consultants are behind it.