All A&Es to stay open under proposals for troubled health economy

The proposals, drawn up by doctors and managers in Devon, are the result of an acute services review, which forms part of the county’s efforts to sustainably deliver healthcare in future.

But the plans will be contingent on a significant workforce restructure, including requiring consultants working across different sites, which leaders accept will be a key challenge.

Devon faces a £557m deficit by 2020-21 under a “do nothing” scenario, and northern, eastern, and western Devon is one of the areas still subject to NHS England’s success regime.

Since January more than 100 clinicians from the county’s four acute hospitals, NHS managers, GPs, and patient representatives have reviewed acute services, with a focus on urgent and emergency care, stroke and maternity.

Among their recommendations are:

• All four acute trusts in Devon – Royal Devon and Exeter Foundation Trust, Plymouth Hospitals Trust, Torbay and South Devon FT, and Northern Devon Healthcare Trust – retaining their emergency departments.
• Developing two hyper-acute stroke units at the Plymouth and Exeter trusts.
• Co-locating midwife led units to run alongside the clinician led units at Plymouth, Northern Devon, and Torbay and South Devon (Royal Devon and Exeter already has one). Reviewing the futures of “underutilised” midwife led units at Newton Abbot, Okehampton, Tiverton and Honiton.
• Reconfiguring histopathology services to ensure future services are delivered using a “networked consultant workforce” that delivers services across potentially several counties.

The recommendations have been endorsed by the programme delivery executive group, which is made up of all members of the Wider Devon sustainability and transformation partnership.

Modelling and costing will now be carried out in the next three months, which – if successful – would pave the way for the planned changes.

Lack of available staff and financial pressures pose the biggest threat to the plans, according to Phil Hughes, medical director at Plymouth Hospitals.

Dr Hughes, who was the clinical lead for the acute services review, told HSJ: “If we can’t get the staff then these plans may not be possible to implement.”

He said the county “does not need to recruit many new staff” but consultants working across several sites and developing more physician associates and advanced nurse practitioners will be key.

“The challenge going forward is to develop a network where consultants who are appointed deliver a service to a group of hospitals as part of a system,” he said.

“We will also be looking at developing staffing models with advanced nurse practitioners in emergency departments.”

Each trust’s type one emergency department will remain open 24/7 under the proposals.

Asked about the proposed new hyper-acute stroke units, Dr Hughes said Plymouth and Royal Devon and Exeter were “not far away” from fulfilling the requirements to provide the service, meaning existing facilities could be upgraded.

If the units are created, seriously ill stroke patients would get intensive treatment there for up to three days, before moving to their local acute stroke unit in one of the four trusts.

On histopathology, Dr Hughes said the review revealed that Devon is set to lose 40 per cent of the sector’s 50-odd team of consultants in the next three years, and there are just two trainees in the South West.

“We’re looking at developing a supportive network of consultants across the four sites who can deliver services to the wider system,” he added.

The network could include links with Cornwall and potentially a reciprocal arrangement with Bristol in highly specialist areas, Dr Hughes said.

But he added no laboratories in Devon have been earmarked for closure under the current plans.