The cuts to Dorset health services

Background

Due to cuts to funding year after year, and attacks on staff terms and conditions, Dorset has both funding and staffing problems that Dorset Clinical Commissioning Group hopes to address by cutting the number of sites that offer NHS emergency care, and by closing NHS beds, departments, and community hospitals.

Dorset Clinical Commissioning Group projected an annual budget revenue deficit of £158 million, resulting in plans to downgrade Poole Hospital A&E, and close Poole Specialist Maternity, leaving only one A&E, and only one Maternity department, at Bournemouth Hospital to serve the conurbation catchment area and West Hampshire, despite a projected growing and aging population. Poole Children’s unit will also be relocated at Bournemouth Hospital, with Poole’s award-winning Cancer service broken up, and Oncology beds moved to Bournemouth Hospital.

Bournemouth Hospital is in the far east of the County, on the border with Hampshire, on the other side of the chronically traffic congested conurbation. Dorset is a dispersed, largely rural County, with no motorways and poor public transport. The loss of emergency adult and children’s medical and trauma care, and the loss of specialist maternity care from Poole, mean lengthy journeys to hospital in emergency, beyond safe guideline times, for whole tranches of the Dorset population. Distance is also likely to affect visitor’s ability to support loved ones in hospital and the take up of nonemergency care.

Dorset Clinical Commissioning Group’s cost-cutting plans also involve the closure of one Community Hospital, and the loss of all beds in a further 4 of the 13 Community Hospitals that Dorset once had. Some beds have also been cut in the remaining 8 community hospitals – Bridport Community Hospital has lost 20 of its 44 beds, for example.

The plans also include the closure of 245 acute hospital beds. Although beds are projected to increase at Bournemouth Hospital, 2/3 of Poole’s beds and a tranche of Dorset County Hospital’s beds are scheduled to close, with a net loss of 245 acute beds.

Continuing concerns

So far Dorset Clinical Commissioning group’s plans have resulted in the closure and sale of Ferndown Community Hospital, the closure of all beds at Wareham and Portland Community Hospitals, and the closure of half the beds at Bridport Community Hospital.

Until new buildings are in place at Bournemouth Hospital, A&E and Maternity units cannot be closed at Poole Hospital, nor can the specialist Children’s unit or Poole’s award wining Cancer service beds be moved to Bournemouth Hospital. Therefore, it remains a matter of years before the planned changes can be fully implemented.

Defend Dorset NHS residents campaign group have, to date, made submissions to the Secretary of State, the Competition and Markets Authority and at Judicial Review and Appeal at the Royal Courts of Justice (2018/2019), highlighting in detail that tens of thousands of people in rural Dorset will be adversely affected by these developments.

In putting forward their proposals, the Dorset Clinical Commissioning Group (CCG) did not properly consider the rural context of so much of the county

 Dorset residents put at risk

Many of its residents live far from hospital services, are low waged, elderly and are not car owners. Public transport is infrequent and expensive. Closing community hospitals and merging Poole and Royal Bournemouth Hospitals would move hospital services out of reach for them in an emergency and deter access to hospital care

The Patient Benefits Case set out by the CCG, moreover, is seriously flawed. There will be increased risk to life, and of lives lived in disability. Reduced access to A&E and Maternity will result in distant over-subscribed services poorly served by public transport

Patients needing a higher level of care will be put at risk through hospital transfers: reductions in the numbers of acute beds will create further risks to patient safety

Reduced acute services, in sum, will struggle as a result of rurality, cuts, an aging population, the failure to put in place integrated community services and the failure of existing services to reverse the trend of rising demand for acute services

Flawed Patient Benefits Case

The Patient Benefits Case is poorly evidenced, repetitious, and aspirational.

No proper clinical risk assessment of the Merger Plans has been carried out. The “Report” cited at the Royal Courts of Justice was based upon a tiny sample of ambulance patients and was very seriously methodologically flawed.

No mitigation plans have been offered by the CCG in relation to risk to life and lives lived in disability.

The Bournemouth Echo in 2019 reported: “Defend Dorset NHS has warned that the changes would put hundreds of people every year at ‘substantial risk’ of harm”.

A Dorset A&E doctor said that up to 183 lives might be lost per year because of ambulances taking longer to reach A&E in Bournemouth.

The A&E doctor noted that this figure did not include those emergency patients not arriving in ambulances: 80% of maternity, perhaps 95% of child, and a significant number of adult emergencies. Freedom of Information Act requests since have in fact indicated that 2/3 of all emergency admissions do not arrive at A&E by ambulance.

All non-ambulance emergencies were excluded from the only risk assessment undertaken, which was, furthermore, fundamentally methodologically flawed. The panel of Clinicians appointed by the Clinical Commissioning Group in 2017 to consider the risk revealed by this risk assessment reported that it was ‘not fit for purpose’ as it excluded all emergency cases not arriving by ambulance.

Furthermore, the Clinical Commissioning Group’s own Equality Impact Assessment reported that longer journeys during labour, birth, and for child emergencies were a ‘significant risk’.

Swanage and Purbeck Ambulance Car at risk

It is also a matter of deep concern that despite reassurances from the Clinical Commissioning Group that, with the loss of emergency care from Poole, ambulance resources would be increased to the rural areas worst affected by long journey times to hospital, we understand that Swanage and Purbeck are losing their Paramedic Car at the end of December – see: Lives put a risk – plans to withdraw Swanage & Purbeck’s Ambulance Car