STRUCTURE: Controversial proposals to transfer patients between hospital sites at a struggling North West trust have been revealed.

North Cumbria University Hospitals Trust has published a “clinical options appraisal” detailing its “early thinking” on how several of its services could be put on a sustainable footing.

Under the proposals, high risk medical patients could be transferred from the trust’s West Cumberland Hospital to Cumberland Infirmary in Carlisle.

Cumberland Infirmary, Carlisle

High risk medical patients could be transferred to Cumberland Infirmary in Carlisle

Another recommendation suggests changing the paediatric inpatient service in West Cumberland to a 24 hour short stay assessment unit.

Children requiring longer hospital stays would be transferred to a full inpatient unit at Cumberland Infirmary.

North Cumbria has struggled with clinical problems for a number of years because of recruitment difficulties due to its geographical isolation, particularly at West Cumberland.

It was one of the trusts placed in special measures in 2013 following NHS England medical director Sir Bruce Keogh’s review of trust’s with unusually high mortality rates.

While the trust has improved in this area, it remains in special measures after a Care Quality Commission inspection in April gave it a rating of “requires improvement”.

North Cumbria’s medical director, Jeremy Rushmer, said it needed to make changes to tackle the concerns about its clinical standards “once and for all”.

In particular the trust has flagged worries about the “extreme fragility” of acute medicine at West Cumberland, which is largely staffed by locums and was rated inadequate in terms of safety by the CQC.

Dr Rushmer said: “The potential solution we have outlined to transfer certain patients to Carlisle, will not only help us provide a sustainable model of care that is robust in the long term, this will also help us attract aspiring candidates, working as part of wider clinical teams, to West Cumbria so that we can stabilise the local workforce.”

In addition to moving patients to Carlisle, North Cumbria hopes to deliver more planned care at West Cumberland, including bringing back over 4,000 outpatient appointments to the hospital.

The trust is also weighing up the future of its maternity services, but this is dependent on the outcome of an independent review being led by Cumbria Clinical Commissioning Group.

While the “clinical options appraisal” is not a formal consultation document, North Cumbria will now embark on a period of engagement before sharing final recommendations with Cumbria CCG.