Details on a wave of reconfigurations are emerging as regions follow London’s example by concentrating services into a smaller number of specialist units.

The details have shed light on plans to establish networks of services for hyper-acute stroke care, major trauma and vascular surgery.

In the South Central region the proposals have proved controversial, with trusts divided over how best to deliver care for patients.

Portsmouth Hospitals Trust objected to plans for Southampton General Hospital to provide emergency and elective complex vascular surgery to patients in southern Hampshire.

During the consultation, more than 6,000 copies of a letter distributed by a local newspaper in favour of keeping the services in Portsmouth were received.

A report, published by the region’s primary care trust clusters on Wednesday, also proposed two major trauma centres for the region, at John Radcliffe Hospital in Oxford and Southampton General.

Although Portsmouth was designated to deal with less severe cases, the report said: “Portsmouth highlighted its status as the second largest provider of trauma services within the South Central SHA area and its unique ability to provide specialist orthoplastic services.

“As such PHT was clear that the long term sustainability of the major trauma centre at Southampton should not be dependent on the resources of other trauma units.”

The review also proposed changes to hyper-acute stroke services, with Winchester and Eastleigh Foundation Trust to become the main provider for hyper-acute services in north Hampshire.

Basingstoke and North Hampshire would only provide acute stroke and rehabilitation services, while St Mary’s would become the hyper acute provider on the Isle of Wight.

The study concluded that further consultation would be neede. A formal public consultation will be undertaken once proposals have been developed.

Changes to vascular provision in the north west, also announced on Wednesday, have divided trusts in that region.

In a letter sent to staff, chief executive of Warrington and Halton Hospitals Foundation Trust Mel Pickup said a decision to concentrate services in Cheshire and Merseyside to two centres was “disappointing”.

She said: “We believe there is strong evidence for three designated centres within the area but the members of the review panel disagreed.

“Our proposal was about the best patient care for our local patients.”

On Monday, the West Midlands Specialist Commissioning Group approved plans to establish three trauma networks in the region.

These will be based around major trauma centres at the Queen Elizabeth Hospital, Birmingham, the University Hospital North Staffordshire in Stoke and the University Hospital of Coventry and Warwickshire.

Each centre will be supported by trauma units, specialist rehabilitation hospitals and local emergency hospitals. The system will be introduced from March 2012.

Frenchay Hospital, run by North Bristol Trust, was also approved to be the centre of the Severn major trauma network, covering Somerset and parts of Gloucestershire.

On Tuesday, the joint board of the County Durham and Darlington primary care trust approved a recommendation to consolidate stroke services onto a single site at the University Hospital of North Durham, despite objections from local councillors.

Cluster chair Lady Ann Calman said the move was based on “greater capacity to provide specialist diagnostic facilities for the majority of people” in the country, and would also allow “speedier access to vascular surgery”.

Professor Tony Rudd, programme director for stroke at the Royal College of Physicians, who is also clinical director for stroke in London, said advances made in the capital were now being adopted around the country.

In July 2010, London established eight hyper-acute stroke units, which have cut length of stay by six days to an average of 15.

Professor Rudd told HSJ: “The lessons from London have been that a major top-down reconfiguration has been very effective for stroke”, and that similar results could not have been achieved solely with market forces or enhanced tariffs.

The approach worked best for “complex, rare interventions”, he said. “Many hospitals around the country where surgeons are doing under 10 such operations a year – there’s no way that can mean they’re maintaining their skills at a level that can be considered adequate.”

Professor Rudd added: “Hospitals will put up a fight – they don’t want to lose out on providing services – people complained but they came to terms with it eventually.”

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