Services in the spotlight

THE first of four meetings aimed at getting the public involved in the future shape of services at Hinchingbrooke Hospital got under way as we went to press last night (Tuesday) IAN MacKELLAR looks at the services thrown into the spotlight.

LAST night's meeting examined the possible future of general surgery. A second meeting tomorrow evening (Thursday) at Slepe Hall, in St Ives will look at obstetrics (maternity).

Next week, the road show moves to the Millennium Centre, in Buckden, on Monday to dissect A&E and general medicine, followed by cancer services back at Slepe Hall next Wednesday.

The hospital says the review of services at Hinchingbrooke Hospital is not just about saving money. While there is an urgent need to stem the hospital's increasing debt, they also need to ensure that services in the area meet the demands of 21st century healthcare and are clinically, as well as financially, sustainable for the next 10-20 years.

That process has now started.

* GENERAL SURGERY: General surgery is a good example of clinical change. There has been a revolution in surgery in recent years. Developments such as keyhole surgery and new anaesthetics mean patients do not need to stay in hospital as long following their operation.

In fact, in the past 20 years there has been a 341 per cent rise in day-case surgery, where patients can be discharged on the day of their operation or the following morning.

Surgery falls into two main areas - elective or planned surgery, which is where a patient requires an operation, such as a hernia, and emergency surgery, where the operation is vital and needs to be carried out reasonably promptly, such as a ruptured appendix.

The need for emergency surgery can, of course, occur at any time.

To be able to provide the right amount of cover to deal with emergency cases safely when they happen, a hospital needs to have enough surgical consultants to staff a reasonable on-call rota. Hinchingbrooke, as a small hospital, may struggle in future to sustain its on-call surgical rota if the number of surgeons were to decrease. This would impact on the ability of the hospital to provide safe and timely emergency care.

* OBSTETRICS: Maternity services are also a complex issue. This year, it is expected that just over 2,400 babies will be born at Hinchingbrooke. When compared to other hospitals, this number is low, which means that the comparative costs of providing the service are higher. Babies come when they want to come, and a 24/7 rota is needed for both midwives and obstetricians: the cost of providing this is about the same regardless of the number of births.

There is a great deal of clinical discussion around maternity services and there seem to be three emerging options.

* Keeping the service (with comparatively low deliveries and high costs).

* Providing outpatient services and minor procedures before and after birth, but births taking place at another hospital.

* Keeping a midwife-led service for clinically appropriate situations.

A midwife-led service requires three to four births a day to be viable, and around the country this type of service model is declining. The activity, staffing levels and technology for service provision, along with clinical safety criteria for difficult births, are all still being debated.

While the level of births in the Huntingdonshire area is likely to remain steady, the viability of sustaining full services at Peterborough, Addenbrooke's and Hinchingbrooke is being questioned.

* A & E: THE first issue that needs to be recognised is that the current A&E at Hinchingbrooke does not deal with all accident and emergencies in the area. Some major cases, such as those involving head injuries, go straight to Addenbrooke's Hospital.

Current medical practice calls for full A&E units to have a large array of services immediately available, including surgery, scanning and X-ray, intensive care and much more.

The majority of cases dealt with at Hinchingbrooke are less serious. Many are injuries such as cuts, straightforward fractures and sprains.

Of the cases currently dealt with at the hospital in the daytime, 30 per cent could be dealt with by a GP, 60 per cent by an emergency nurse practitioner or senior house officer doctor and only 10 per cent require a consultant.

Medical staff have calculated that 60 per cent of out of hours cases could be seen by a GP and 40 per cent need hospital staff.

Based on this, the hospital could develop a service where there is a GP with a senior nurse on site 24/7, who would be able to deal with the 90 per cent of the current cases. Consultant support would still be available if required.

* GENERAL MEDICINE & CANCERS: There is an increasing national movement towards providing services such as diabetes, dermatology and rheumatology in the community.

There are many examples across the country where these services are now provided in local clinics by specialist nurses or in GP surgeries by GPs with a special interest in the condition. These services have a very high satisfaction rating from the patients they care for.

Much of this also links in with the move to help people with long-term conditions, such as diabetes or heart failure, manage their conditions better and so prevent problems which may lead to a hospital admission arising in the first place.

Cardiology could transfer to Papworth and a joint venture with Peterborough Hospital is already under way for in-patient haematology. There is further scope for joint working with other specialities, the Strategic Health Authority believes.

Other services, such as rehabilitation following heart attacks or strokes etc, need to be locally provided, but this could be in a joint venture with the PCT. Physiotherapy at the hospital is already run by the PCT.

Hinchingbrooke is a cancer satellite, with many major surgical treatments being done off site, but there is a need to continue day treatment, clinics and diagnostics to ensure easy access to local people.