The must-read stories and debate in health policy and leadership.

Centralised where?

Stroke reconfigurations always cause local concern, even when they are done for the best of reasons – to improve outcomes.

Two years ago, plans to centralise services in West Sussex were “paused” because of concerns that putting services at either Worthing Hospital or St Richard’s Hospital in Chichester would increase pressure on other units nearby which would inevitably be closer for some patients – for example a service moved to Chichester might mean some patients were left nearer Brighton. There the matter seemed to rest until NHS England started to put pressure on Coastal West Sussex Clinical Commissioning Group to revisit centralisation this summer.

In the meantime, both the Worthing and Chichester units have improved their rating in the national stroke audit providing 24/7 thrombolysis and stroke nurse cover.

Centralising stroke to create a single hyper acute unit is likely to raise concerns about large numbers of elderly people facing additional travel times – the two hospitals are 20 miles apart and the road journey is along the congested A27. Neither the CCG nor the trust sound overly enthusiastic about the process; whichever hospital is not chosen is bound to be portrayed as “losing out” or in some way being “downgraded.” If proposals for centralisation do come forward for public consultation early next year, expect a reception as icy as the winter weather.

Trust ‘lunacy’?

Is it a good idea for a trust to reduce its bed base before winter? Not according to the Royal College of Emergency Medicine’s vice president who called the Dudley Group Foundation Trust’s actions “tantamount to lunacy.”

Figures the trust shared with HSJ showed its bed base reduced from 679 in June 2017 to 637 in December.

This coincided with the trust having a very difficult winter which resulted in its being rated “inadequate” by the Care Quality Commission following a December inspection.

One member of staff told HSJ the cuts to bed base impacted the trust’s accident and emergency performance.

In response to HSJ’s queries on why it reduced the bed base the trust said over the period it had had 44 escalation beds available.

It added bed numbers were “remodelled” to give the “maximum” number of beds in medicine.

This included converting a 25 bed space into a rapid medical assessment and ambulance triage.