ICS to push ahead with contentious reconfiguration

The proposals, drawn up by Gloucestershire Integrated Care System chiefs, are expected to be given the green light by the local clinical commissioning group on Thursday.

The plans will see emergency general surgery, vascular surgery and acute medicine centralised at Gloucestershire Royal Hospital, while orthopaedic and gastroenterology services will be moved to Cheltenham General Hospital.

It comes despite previous warnings from more than 50 consultants and doctors at Cheltenham that moving emergency general surgery to Gloucester could put patients at risk.

The reconfiguration is not quite a full split of emergency/elective (known as hot/cold) services, because Cheltenham General will retain its reduced hours emergency department. The ED was closed last spring as part of the trust’s response to the pandemic, but it is set to re-open this summer.

Both hospitals, which are only eight miles apart, are run by Gloucestershire Hospitals Foundation Trust. Campaigners in Cheltenham told HSJ they oppose the reconfiguration.

The hot/cold split was recommended for multi-site acute trusts by the Five Year Forward View and reiterated in the NHS Long-Term Plan.

ICS leaders say in their business case that the current set-up risks wasting resources and compromises “quality, productivity and staff recruitment and retention”.

For example, Cheltenham’s emergency general surgery services are not compliant with the South West Clinical Senate’s requirement for access to a surgical assessment unit, while access to emergency theatres at both hospitals is leading to “sub-optimal…care” within the service.

The trust also has a 43 per cent vacancy rate for acute medical physicians, and there are shortages in radiology and pressures on the gastrointestinal surgical staff which could result in the withdrawal of trainees from the specialty.

The ICS therefore wants Gloucestershire Royal to “focus more on emergency care” and Cheltenham General to focus on “planned care and oncology”.

Under the proposals, 34 beds will be closed at the 346-bed Cheltenham General while 551-bed Gloucestershire Royal will receive an additional 41 beds.

The decision equates to a loss of services to Gloucester which “threatens the long-term viability of Cheltenham General”, according to Chris Hickey, the spokesman for Restore Emergency at Cheltenham Hospital.

Mr Hickey also claimed the public consultation process had been “flawed” given that it had been carried out during the pandemic (between October and December 2020), and that its organisers had “buried” proposals on bed cuts in lengthy documents which were “overly technical and too difficult for the ordinary person to understand”.

However, NHS England/Improvement has said it is assured the project’s process has satisfied all requirements, according to the business case.

The proposals will be voted on by Gloucestershire CCG at an extraordinary governing body meeting on Thursday.