Seeking the right remedy

THE widespread popular anger that greeted this week’s proposals to downgrade women and children’s services at the Friarage Hospital, Northallerton , is a stark illustration of the contradiction between the Government’s promotion of “localism” and the reality on the ground.

When the Coalition Government came to power in May 2010 one of the key policies was to decentralise power to more locally-based organisations.

In the NHS, this involved controversial moves to abolish regional and area health authorities and put groups of local family doctors in charge of budgets.

At the same time, there has been an NHSwide emphasis on making more information on services available to the public with the intention of giving patients more choice.

Clearly, most people who live in the Friarage Hospital’s catchment area want to retain as many services at their much-loved local hospital as possible.

But – as we learned this week – the first major decision likely to be taken by the new GP-led Hambleton, Richmondshire and Whitby Clinical Commissioning Group (CCG) will be to back highly unpopular plans to downgrade women’s and children’s services.

The CCG wants to see the maternity unit at the Friarage turned into a midwife-led unit that would only take women expected to have straightforward births.

Any women likely to have medical problems will have to have to travel to the fully-staffed maternity units at either The James Cook University Hospital, in Middlesbrough, or Darlington Memorial Hospital.

The CCG also believes that the consultantled children’s unit at the Friarage needs to be replaced with a more modest short-stay paediatric children’s assessment unit.

Again, children with serious problems or who needed to be admitted would have to be be seen in either Middlesbrough or Darlington The proposals, which will have to be endorsed by NHS North Yorkshire and York at a meeting in York on September 25, have led to hundreds of placard-waving demonstrators marching through Northallerton and triggered denunciations from local politicians, from councillors to MPs.

Dr Vicky Pleydell, the shadow accountable officer at Hambleton, Richmondshire and Whitby CCG, argues that the difficulty in attracting specialist medical staff to the smallest district general hospital in England means that the current level of service is no longer viable for the future.

The Catterick Garrison GP insists that the responsible thing to do is to act now to ensure that a more viable, safer model of care is in place at the Friarage.

She is also adamant that this is not about money – even though the NHS in North Yorkshire is trying to avoid running up £19m debts during the current financial year.

Despite her pleas, it seems as if local politicians and the community as a whole will fight the proposals tooth and nail.

One view among North-East health experts is that the demonstrators should think very carefully about the advice from local doctors before taking to the streets again.

Alan Maynard, pictured, is a highly-regarded professor of health economics at York University and also chairman of the Vale of York CCG.

He is struck at the parallel between the opposition to changes at the Friarage and the attitude of campaigners in Leeds who are refusing to accept the advice of a national panel of experts that it is safer to centralise children’s heart surgery at Newcastle and Liverpool and close the specialist heart unit in Leeds.

“It is exactly the same problem. The experts in this field are saying we think we need to reconfigure our service on the basis of evidence.

The message is that we should get better quality care, but you and your children may have to travel further.”

Prof Maynard accepts that we may be sentimental about smaller hospitals but he insists that we have to leave the emotions behind and listen to the experts.

“The CCG’s role is to provide the best quality care within their budget and you could be very blunt and say to people, ‘do you prefer local services that may be unsafe or do you prefer services which are not local but are safe.

What do you want for your fellow adults? What do you want for your children?’”

“The best advice is saying we should reconfigure in this way and if the advice is sound – which it appears to be – the choice is for the community.”

But Professor Ian Greener, from Durham University’s School of Applied Social Sciences, questions whether the CCGs proposals have any legitimacy when the entire local population appears to be against the proposals.

“If the Government is saying the NHS is all about patient choice and local responsiveness – and that is why we have spent a fortune on reorganising the Health Service – the logic of all this is not about closing local hospital services, is it? People will still want to send their children and pregnant women to Northallerton because that is the service that they want.”

Prof Greener accepts that if a hospital says it is unable to staff a service to a safe level, then there is no question that the service had to change.

“But if this is really about the idea that you can get better care elsewhere, where does that end?”

He argues that both sides could consider what he calls “a trade-off”, so that the current services at the Friarage remain intact but everyone accepts a slightly lower clinical quality.

The alternative, he predicts, is that the more small hospitals are stripped of services the more likely it is that they will eventually be forced to close.