Downgrade proposed for A&E at country's smallest trust

On Tuesday, the North Somerset health overview and scrutiny panel were presented with five options for redesigning patient services at Weston General Hospital.

Four out of the five options proposed would involve permanently closing the accident and emergency department overnight, which the trust has struggled to safely staff for years. One proposal would reduce it to an urgent treatment centre.

The trust’s A&E has been closed “temporarily” overnight since June 2017. This followed the Care Quality Commission rating the service “inadequate” and noting the hospital often had to keep patients in corridors that were “not a safe environment for emergency care and treatment”.

Since then, patients have had to travel to Bristol or Taunton if they need care overnight. 

All options proposed would include an increase in community services and routine electives offered at the hospital, including new frailty services, non-complex procedures, and mental health services.

The options proposed are:

• Re-opening a full 24/7 A&E service, including acute emergency surgery. The trust has been attempting to recruit consultants to fully staff and re-open the department overnight for more than a year, thus far without success;
• Permanently downgrade the consultant-led A&E to a day-only site in-line with the current provision and continue to provide emergency surgery provision during the day.
• Downgrade A&E to a consultant and GP-led day-only unit, which would continue to deal with some, but less, complex and emergency surgery, and only five days a week.
• Downgrade to a GP-led medical emergency centre, open during the day and dealing only with serious but stable patients, five days a week.
• Downgrade to a GP-led urgent treatment centre, open during the day for urgent care that is not life-threatening and not offering any complex surgery.

Bristol, North Somerset and South Gloucestershire clinical commissioning group, which put forward the proposals for change, noted that, even under the urgent treatment centre option, 88 per cent of people currently using the hospital would continue to do so.

However, attempts to reduce emergency services at Weston General Hospital have long faced strong local opposition. NHS Improvement chair Dido Harding’s husband, John Penrose, is the Conservative MP for Weston.

The trust has also been increasingly reliant on its larger neighbour, University Hospitals Bristol Foundation Trust, to help run its existing A&E services. In January, it was proposed the two trusts merge, but there has been little progress since.

The options will go to public consultation from early 2019, with a final decision expected in autumn.