Tuesday 2nd April 2019

Comments and questions for South Tyneside CCG regarding their latest "working ideas" for Phase-2 of the "Path to Excellence"

The Save South Tyneside Hospital Campaign has submitted the following comments and questions to the CCG in response to their request for views regarding their "working ideas" as presented in their 24 page summary "Working Together for Clinical Excellence: Phase-2 Updated Case for Change".

1. Baseline for Understanding Changes

   The glaring thing about the "hurdle criteria" and the "working ideas" is that there is no information on what services are provided now. There are no details of acute services that are currently being delivered in South Tyneside District Hospital - or Sunderland for that matter - and what the CCG and Trust intend to change regardless of whether the change is 'minimal', 'some' or 'greater'.

   We note that the proposals seem to favour 'greater' change.
2. A&E

   What are the different models of urgent care being pursued?

   The type of A&E we have now includes pathways for single emergency trauma and ambulatory care. Ambulatory care manages patients' acute lont-term health problems so that they don't have to be admitted to A&E, but should the need for emergency care arise, then ambulatory care patients are already close to the A&E. In addition, our A&emp;E includes an admissions ward, Intensive Care Unit (ITU), Coronary Care and other acute services.

   What will these change options provide? For example, Option 3 "Urgent Care" is at most a walk-in or referral from 111 for minor injuries and illness. The document doesn't say what other services this will remove like the ITU, etc. How can people make a decision if they are not being given the facts of these working ideas?
3. Surgery

   What exactly in the proposals will constitute a "Centre of Surgical Excellence"?

   All options remove emergency surgery, which is currently some 10 lists a week. What is the impact of that?

   Without emergency surgery can A&E admit emergency care or trauma?

   We have concerns about losing laparoscopic bowel surgery, which is a world innovation at South Tyneside District Hospital. Is this staying?

   If laparoscopic bowel surgery is not staying, then it surely makes the claim that South Tyneside District Hospital will become a "Centre of Surgical Excellence" as meaningless as the "Path to Excellence".

   It looks like there is a plan for South Tyneside District Hospital to do 'day surgery', ENT surgery (Ear, Nose and Throat) and maxillofacial surgery (Maxfax - face and neck) as equipment has been ordered already. South Tyneside District Hospital does not do this currently. Is this what is being added in order to call it a "Centre of Surgical Excellence"? - But again, what about the trauma surgery and bowel surgery?
4. C-Pex Service
   We have concerns about losing the C-Pex service that is not offered at City Hospitals Sunderland. This is a very in-depth pre-operative assessment for all lap/bowel patients. The result of the test determines whether the patient goes to a High Dependency Unit (HDU), Intensive Care Unit (ITU) or a ward. Because of the C-Pex assessment, most patients are able to go to the main ward safely for their post operative care and not use HDU or ITU services.
5. Orthopaedics, Hips and Knees
   Sunderland patients are already coming to South Tyneside for Hips and Knees, so why is this new?
6. Trauma & Hospital Viability
   We have concerns about losing trauma, which will go to City Hospitals Sunderland. Will this have a financial impact on South Tyneside District Hospital as a 'going concern' if all the emergency surgery is moved to Sunderland?
7. Terms, Conditions, and Access

   What are the new roles for staff working across sites, and will they be transferred under TUPE (Transfer of Undertakings Protection of Employment) rules to "Choice" (a private company)?

   What will the transport and parking situation be for staff and patients?