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Independent Clinical Review recommends changes to Worcestershire’s Hospitals

The expert Panel leading the Independent Clinical Review into the future of acute hospitals in Worcestershire has recommended: 

  • Creation of a networked ‘Emergency Centre’ at the Alexandra Hospital. Hospital based emergency services across Worcestershire will be networked and led by consultants with an ‘Emergency Centre’ at the Alexandra Hospital and a ‘Major Emergency Centre’ at the Worcestershire Royal Hospital 
  • Consultant led maternity services should be centralised at WRH but Redditch and Bromsgrove CCG should consider commissioning a stand-alone midwife-led birth centre for North Worcestershire. 
  • Paediatric inpatients should be centralised in Worcester but a day-time consultant-led paediatric assessment unit at the Alex would accept referrals from GPs and other professionals. 
  • The Clinical Commissioning Groups and Worcestershire County Council should review the public transport links between North Worcestershire and the Worcestershire Royal Hospital. 

The Panel, which was made up of clinical experts from across the UK, did not support Option 2, which would have seen another provider take over services at the Alexandra Hospital as this would have resulted in a significant inequality in the provision of safe and sustainable services to the population of Worcestershire. 

The Panel recommends a modified version of Option One should be put to public consultation. 

The Panel’s key recommendation is that it did not support the closure of the emergency department at the Alexandra Hospital. Instead there should be a new networked ‘Emergency Centre’ at the hospital. This recommendation echoes the plans outlined by NHS Medical Director, Sir Bruce Keogh, in his recent report into urgent care. The new ‘Emergency Centre’ would bring together a 24hr ambulance receiving emergency department for adults and a 24hr GP-led Urgent Care Centre (UCC) with a Minor Injuries Unity for both children and adults at the Alexandra Hospital. A day-time consultant-led Paediatric Assessment Unit would accept referrals directly from the UCC and from GPs. The sickest children requiring overnight admission would be transferred to WRH where they would receive specialist care. 

In addition the Alexandra Hospital will become a county wide centre of excellence for orthopaedic services and will continue to be a county wide centre of excellence for urology services.

Mr Nigel Beasley, Chair of the Independent Clinical Review Panel, said, “We were consistently impressed by the focus on the best interests of patients described by commissioners and provider teams that we met during the review and we hope that by bringing an independent expert clinical voice to the programme we can contribute in a positive way to the ‘Future of Acute Hospital Services in Worcestershire’. We recognise that the provision of safe and sustainable health services requires safe and sustainable organisations with sufficient numbers of patients to maintain skills and expertise. 

“In the report we have aimed to achieve a balance between access to local services and improving the quality of those services; only supporting proposed changes where we felt that this was in the best interest of the whole population of Worcestershire. We believe that our recommendations support the development of clinically safe and sustainable health services both now and in the future.” 

Dr Jonathan Wells, Chair and Clinical Lead of NHS Redditch and Bromsgrove Clinical Commissioning Group, said, “We welcome the report of the Independent Clinical Review Panel. It provides compelling clinical reasons for the reconfiguration of acute hospital services across Worcestershire and secures the future of the Alexandra as a vibrant local hospital. The range of services recommended is significantly better than was initially proposed last year. We particularly welcome the Panel’s firm recommendation that an Emergency Department must remain at the Alexandra Hospital, and their call for consideration of a midwife-led birth unit. We are pleased that option 2 was fully reviewed and note the Panel’s findings. We will continue to work with our NHS colleagues in further defining this new enhanced option one and ensuring it works for our patients and for the rest of the County. In particular we recognise that public transport links between Redditch and Worcester must be improved.” 

Penny Venables, Chief Executive of Worcestershire Acute Hospitals NHS Trust, said, “I would like to thank the members of the Independent Clinical Review Panel for the work they put in to evaluating the options for the people of Worcestershire. I believe they have described a very workable solution which will serve Worcestershire for many years.” 

The clinical recommendations will now be considered by the three Worcestershire Clinical Commissioning Groups and Worcestershire Acute Hospitals NHS Trust. The financial implications of the modifications to the original Option One will also be worked up. 

If all the boards support the recommendations they will be put out for public consultation in the autumn. 

Read full report


Notes for Editors:

The Joint Services Review (JSR) was initiated in January 2012 to look at how high quality, safe and affordable acute hospital services by Worcestershire Acute Hospitals NHS Trust could be sustained into the future. 

The JSR project was completed in March 2013 with a set of recommendations proposed by the Worcestershire Clinical Senate. These recommendations were proposed on the grounds that they would be best for ensuring safe and clinically sustainable services for the people of Worcestershire. The recommendations focused on centralising the current consultant-led maternity services, overnight children’s services and full A&E services provided by WAHT on the Worcestershire Royal Hospital (WRH) site. 

The two different models for how the services could potentially be provided and these were recommended by the Clinical Senate:

Option One: Worcestershire Acute Hospitals NHS Trust continues to run an amended range of services across its three hospital sites.

Option Two: An alternative provider manages services from the Alexandra Hospital in Redditch, with Worcestershire Acute Hospitals NHS Trust continuing to run services in Worcester and Kidderminster. 

Mr. Nigel Beasley: co-Chair East Midlands Clinical Senate.

Nigel is co-Chair of East Midlands Clinical Senate and a consultant ENT surgeon at Nottingham University Hospitals NHS Trust. He was a student at Guy’s Hospital in London, and then trained in Nottingham, Liverpool, Oxford and Toronto, before returning to Nottingham as a consultant in 2002. Nigel was Clinical Director of ENT from 2004 to 2007 and then worked with the NHS Institute for Innovation and Improvement as their clinical lead for cancer from 2007 to 2008. He was Deputy Medical Director at Nottingham University Hospital between 2007 and 2013 responsible for appraisal and revalidation, and clinical effectiveness. In 2010 Nigel was appointed as clinical lead for the QIPP Right Care Workstream for the East Midlands SHA and then took on the national clinical lead role in 2012, leading the development of value based commissioning guidance for elective surgery.

Nigel’s role is to lead the Independent Clinical Review Panel which is responsible for reviewing the work that has taken so far, and what the next steps will be.

Keogh Report

The Medical Director of NHS England, Sir Bruce Keogh’s, review of urgent and emergency care proposes a fundamental shift in provision of urgent care, with more extensive services outside hospital and patients with more serious or life threatening conditions receiving treatment in centres with the best clinical teams, expertise and equipment. Developed after an extensive engagement exercise, it proposes a new blueprint for local services across the country that aims to make care more responsive and personal for patients, as well as deliver even better clinical outcomes and enhanced safety. 

The report (available on the NHS Choices website) makes proposals in five key areas:

providing better support for people to self-care 

helping people with urgent care needs to get the right advice in the right place, first time –the NHS will enhance the NHS 111 service so that it becomes the 'smart call' to make, creating a 24 hour, personalised priority contact service.

providing highly responsive urgent care services outside of hospital so people no longer choose to queue in A&E –putting in place faster and consistent same-day, every-day access to general practitioners, primary care and community services ensuring that those people with more serious or life threatening emergency needs receive treatment in centres with the right facilities and expertise in order to maximise chances of survival and a good recovery –once it has enhanced urgent care services outside hospital, the NHS will introduce two types of hospital emergency department with the current working titles of emergency centres and major emergency centres. 

connecting urgent and emergency care services so the overall system becomes more than just the sum of its parts –building on the success of major trauma networks, the NHS will develop broader emergency care networks. 

Media enquiries: 

For CCGs, please contact Hardeep Cheema, on 07423 534211/ 01905 5681978 or email Hardeep.Cheema@worcestershire.nhs.uk

For NHS England, please contact Gemma Coldicott on 07867 458996 or email gemma.coldicott@nmecomms.nhs.uk

For Worcestershire Acute Hospitals NHS Trust, Rebecca Bourne, on 01905 760453 or email Rebecca.Bourne@worcsacute.nhs.uk