PROPOSALS for the future of emergency healthcare have been outlined – and Dorset County Hospital’s A&E department is safe, but consultants will not be on hand 24/7 like they will in east Dorset.

The award-winning accident and emergency department in Dorchester will not be cut as part of the Dorset Clinical Commissioning Group's (CCG) major review of the county's health services- but it will only have specialist consultants available 14 hours a day.

The plans have been outlined ahead of a top-level meeting of the CCG's governing body on Wednesday and if given the green light, could be implemented by next summer – sparking fears patients would have to travel to east Dorset for treatment.

CCG chairman Dr Forbes Watson spoke exclusively to the Echo yesterday about the plans, following media reports over the weekend that A&E consultants would be cut. Dr Watson categorically denied this is the case.

The CCG launched a major review into the way healthcare is provided last year in the face of changing healthcare needs and mounting debt.

A new major planned care hospital and a new major emergency hospital would be developed at The Royal Bournemouth Hospital or Poole Hospital, with specialist consultants available 24/7.

Specialist consultants would be available up to 14 hours a day at DCH, and an on-call consultant would be working from the major hospital. This is an increase compared to the current consultant care provided at DCH.

Emergency, cardiac and stroke services at DCH would still be provided for 24 hours a day, but if a patient suffered an emergency situation outside of the 14 hour period, to get the best care they would have to be transferred to east Dorset.

Dr Watson said: “It’s very important to say there are absolutely no plans to reduce the hours of the A&E department at DCH, it will stay open 24 hours a day, 365 days a year.

“The vast majority of the current care delivered at DCH will not stop, but what we want to do is develop a major site in the east of the county.

“The other side of this is not only will the majority of care stay at DCH, but we’ll be looking to improve the amount of care delivered in the community, to deliver the care people need to their homes."

Also as part of the plans, the CCG wants to provide better access to GP services for members of the public, more day-to-day care delivered out of an acute hospital setting to people’s homes, and staff working more effectively.

No final decisions have been made on the proposals but if the they get the green light, they will go to public consultation in August and could be implemented from summer 2016.

However, concerns have been raised that due to the rural landscape of south and west Dorset, there could be delays in patients receiving the required treatment.

Dr Watson explained the decision to have the major care site in east Dorset.

He said: “Across the system in Dorset, there are issues with the quality of care delivered, access to care, the affordability of care, the value for money the care provides and the work force. These are challenges we face and are aiming to address with the review.

“We have factored in that the majority of the population of Dorset live in the east of the county and it’s recommended for a population of 750,000 to one million, that to get the best quality of care, you need one major care centre where the doctors with the expert training and specialist skills can be seeing patients 24 hours a day.

“Specialist consultants and doctors will be on hand 14 hours a day at DCH. If somebody had an emergency situation in west Dorset outside of those 14 hours, they would first be treated by paramedics who would decide whether they needed to go.

“It’s been shown through research survival rates are improved by 20 per cent by sending patients to a major care centre and having consultants there 24 hours a day.

“This is about improving consultant care across the service and if the emergency situation is so serious a patient needed to be treated at Bournemouth or Poole, research shows even with the driving time, they have a better chance of survival as they're being treated by doctors on the way and then treated by specialists on arrival.”

Mr Watson added: “The most important thing is consultants will always be available for all patients in all parts of the county all the time. Being a clinician and a GP myself in Lyme Regis, I have no hesitation in recommending this to my patients."

 

A HOSPITAL patient governor has questioned why the 24 hour care won't be developed at DCH- named the best for A&E care in the country. 
Derek Julian said: "DCH has been named the best A & E in the country. So why don't we have the services here?
It's not good enough that patients will have to travel to Bournemouth and Poole for treatment if they need care out of those hours.
"This end of the county deserves consideration. If anything, our services need to expand as more people move in to the area- there is now a significant development at Poundbury and more housing planned. 
"We have got to protect and develop services at this end of the county. 
"We must not put services out of reach for people in Lyme Regis, Bridport, Weymouth, Portland and Dorchester.
"If you are right at the far end of the county imagine the journey you will have to get to the care you need."
A report conducted by Dorset County Hospital's NHS Foundation Trust highlighted the issues that many patients in south and west Dorset are facing.
A quarter of residents in west Dorset have no access or very limited access to public transport, making it difficult for them to reach services on the other side of the county. 
Bosses of DCH, in the trust’s five-year strategic plan, draw on the importance of retaining services in West Dorset.
“Its [West Dorset’s] large area and low population density make it difficult to ensure that patients have access to services, especially the elderly and those dependent on public transport [...]
“The local road network is slow, with no motorway routes or quick emergency transfers. The relatively long travel times for the population in the west of the county to the larger trusts (20-50 miles), make it important to retain and develop access to comprehensive services and integrated healthcare in West Dorset.”
In this plan, they give driving times for patients in West Dorset to access services. 
They state that it would take- and this is ’greatly understated’ and does not take in to account the ‘rural road network, where slow moving vehicles and holiday traffic can cause significant delays’- 71 minutes for a resident of Lyme Regis to reach Poole Hospital.

Our changing healthcare needs

OUR reliance on the NHS is only expected to grow as the population of Dorset increases and ages- and our waistlines expand.
However, there is a £167m gap between Dorset's health spend and its actual budget.
The county has an ageing population that is expected to increase to more than 800,000 by 2023- with the biggest growth in population happening amongst the elderly.
Although overall population will expand by six per cent, there will be 30 per cent more people aged over 70 living in the county.
Due to the elderly population, Dorset has a high number of people with heart problems and diabetes. This is expected increase faster than the national average with one in 10 having diabetes and one in eight living with coronary heart disease by 2020. 
Already, 62 per cent of us are overweight or obese- and in Purbeck this increases to 69 per cent. 
As reported in the Echo, almost a quarter of west Dorset’s reception pupils are overweight or obese, and more than one in four Year Six pupils are also overweight or obese, according to recent research.
In the next 10 years, A & E attendance is expected to grow by 22 per cent and hospital admissions by 30 per cent. 
Unplanned hospital admissions for children currently stand at 16,000 a year. 
In the last year there has been tension between unions and health bosses and staff have walked out several times in a disagreement over pay and pensions. 
Unison South West previously told the Echo that members are having to resort to using foodbanks or take up second jobs as they struggle to pay their bills. 
They say morale is low and NHS staff are 'overworked and underpaid.'
Some say that it is little wonder, then, that Dorset is struggling to recruit qualified staff. In a report seen by the Echo, hospital bosses say staffing is 'the biggest risk to the organisation' and they are failing to achieve the levels of recruitment and retention they need.
They say this struggle is 'consistent with the national picture' at they they are competition with other NHS organisations in a limited pool of applicants.