Deep South: White smoke from Dorset

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White smoke from Dorset CCG

When it comes to reconfiguring acute services, now is the time for NHS managers to make hay while the sun is shining. We’re at the point in the electoral cycle – four years out from a general election (barring any curveballs which the EU referendum might throw up) – when health service leaders have the most room to manoeuvre.

Commissioners in the South West have taken note. Dorset Clinical Commissioning Group is undertaking a “clinical services review”, which hinges on the centralisation of emergency and planned activity on separate sites in the east of the county.

The likely sticking point is that both The Royal Bournemouth and Christchurch Hospitals Foundation Trust and Poole Hospital Foundation Trust desperately want to be the emergency centre.

Dorset CCG has been privately weighing up the relative merits of the two organisations for months. But last week white smoke was glimpsed billowing from the CCG’s chimney: Bournemouth got the nod.

As expected, the argument between the two trusts was finely balanced. Both organisations were scored the same on the CCG’s criteria for care quality, workforce, research and education, and “deliverability”.

However, Bournemouth inched in front of Poole because the CCG judged it offered better access for patients and because, according to analysis by Capita, it would require about £40m less than Poole to be kitted out as the emergency hospital.

The decision is a bitter blow for Poole. The trust had argued that it was more deserving of the status because it is already the major trauma unit in East Dorset, with a high volume of emergency work. It claimed it was better situated than Bournemouth to serve the rural, western part of the county. On the money issue, it said that while Bournemouth might require less investment to turn it into an emergency centre, potential savings from this option could be cancelled out by the higher cost of turning Poole into a planned care centre.

Dorset CCG’s choice of Bournemouth is due to be signed off by the group’s governing body on Wednesday, but there are still many hoops which the CCG needs to jump through. It will need to get permission from NHS England, and it will also have to satisfy the Competition and Markets Authority that the service redesign will not breach undertakings made to the competition authority after the failed attempt to merge the two trusts in 2013. And that’s even before the plans go to public consultation – local campaigners are preparing to man the barricades, with two petitions to “save” Poole’s A&E attracting more than 50,000 signatures in just a few days.

In other words, commissioners still face a long and hard road to make their vision a reality.

Breathing space for Royal Cornwall

Last week Royal Cornwall Hospitals Trust was rated “requires improvement” by the Care Quality Commission.

The inspection report was a mixed bag. Sir Mike Richards, the CQC’s chief inspector of hospitals, said inspectors had “noted some improvements” since the CQC’s last comprehensive inspection of the trust two years ago. However, he said it was “disappointing that it [had] not made enough progress in all areas”.

Still, the CQC’s findings present an opportunity. Royal Cornwall has been a fragile organisation – insiders told me at the end of last year that there was a genuine possibility the trust could be rated as “inadequate” and placed in special measures. The fact that this has not happened indicates that Royal Cornwall’s leadership will remain in control of its destiny.

Royal Cornwall’s new chief executive, Kathy Byrne, who joined the trust from Australia in April, is highly rated by very senior individuals in the NHS. The CQC’s rating should give her the breathing space to begin the hard work of moving the trust from requires improvement to “good”.