• Trauma work to be taken away from Hinchingbrooke hospital, plans propose
  • Site does not hit volumes for best financial or clinical outcomes on trauma, says STP
  • Move would “constitute a significant service shift”

Cambridgeshire leaders have set out plans to remove all trauma work from a struggling district general hospital as part of a major clinical reconfiguration.

Cambridgeshire and Peterborough Sustainability and Transformation Partnership proposes to “redistribute” Hinchingbrooke Hospital’s trauma work to Peterborough City Hospital and Addenbrooke’s Hospital last. Trauma patients occupy just under 10 per cent of the hospital’s beds.

A paper for the STP’s July board meeting by Caroline Walker, chief executive of North West Anglia Foundation Trust, which runs Peterborough and Hinchingbrooke, said the move would “constitute a significant service shift” and is likely to require public consultation.

The move is part of a major clinical reorganisation which could turn Hinchingbrooke into an “elective hub”, with more non-elective work sent to Peterborough, according to plans set out by NWAFT in March 2018.

The trust has, however, pledged to retain a 24/7 type 1 emergency department led by an emergency consultant at the small district general hospital, which complicates the reconfiguration. This promise was made when Peterborough and Stamford Hospitals FT and Hinchingbrooke Health Care Trust merged to create NWAFT in 2017.

The paper added: “The volume and case mix [of trauma work]… does not meet the expected minimum volumes recommended nationally to maintain standards of excellence, nor does it financially justify the maintenance of different levels of 24/7 orthopaedic rota required in order to maintain a safe service.

“In practice, it has also been difficult to recruit to the middle grade medical roles because the small number of patients does not make this attractive either for trainees or specialty doctors, thus requiring a further cost from locum doctors for an already costly service.”

Addenbrooke’s is the local trauma centre and Peterborough hosts a trauma unit. Hinchingbrooke was using an average 25 beds for inpatient adult trauma patients as of July 2018, the majority of which had had a fragility fracture, predominantly a fractured hip.

The paper added it envisaged “slightly more than half” of these patients would go to Peterborough and the remainder to Cambridge.

It also said that, while considerable work had been undertaken by executives at NWAFT, “to determine viable pathways and expected patient shifts… progress as a STP group has been slow”. Ms Walker said it was hoped the STP would be “moving this forward in the next two month[s]”.

Concerns have long been raised that the reconfiguration of services between NWAFT’s two sites would see Hinchingbrooke’s small accident and emergency department downgraded.

However, the trust told HSJ: “Hinchingbrooke Hospital’s A&E is a 24/7 type 1 service. It is led at all times by an emergency consultant.

“The trust’s clinical strategy published in March 2018 refers to the 2016 STP plan when there were concerns over recruitment challenges. Since the merger and development of the new trust, we have successfully recruited senior medical and nursing staff specialising in accident and emergency services.

“We are committed to running a 24/7 type 1 service at Hinchingbrooke Hospital for the people of Huntingdonshire and the surrounding areas.”

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