What the proposals could mean for you

By Ian Dipple Friday 24 January 2014 Updated: 24/01 16:23

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An explanation of the key changes at the Alexandra Hospital:

A&E

What’s changing?

The accident and emergency department at the Alexandra Hospital will become an emergency centre including a 24/7 GP-led urgent care centre and 24/7 minor injuries unit.

What does this mean for me?

Essentially very little. The department will still deal with the vast majority of what it does now. A total of 38,000 adults walk in to the Alexandra Hospital now and will continue to do so and be treated there in the future. About 15,000 ambulances arrive at the Alex every year, they will continue to do so.

A&E consultants will remain on site with the ability to assess, treat, admit, discharge or transfer patients elsewhere. It would form part of a network with the major emergency centre at Worcester and the treatment centre in Kidderminster, effectively creating one large A&E department over three sites.

Those patients with heart attacks, strokes, major injuries will be taken to the Worcestershire Royal or Queen Elizabeth Hospital in Birmingham as they are currently.

Why change?

The Alex does not meet the recommended consultant numbers to safely deliver a major - or Type 1 - A&E department and the loss of inpatient paediatrics (see below) would have serious consequences for safety and sustainability.

But the panel acknowledged the Worcestershire Royal would not be able to cope with about 6,000 additional ambulances a year turning up at its door.

There was also concern creating a Medical Assessment Unit at the Alex would mean patients with surgical problems or broken bones, being assessed by acute physicians who do not have the expertise needed to assess and treat them, which is why it was proposed the Alex keep its A&E but redesign it under the new national emergency centre model.

Children’s Services

What’s changing?

Inpatient paediatric services at the Alex will be centralised into Worcester once capacity is available, expected to be as much as two to three years away, and there will be the creation of a Paediatric Assessment Unit during the day at times still to be specified along with enhanced community paediatric services.

What does this mean for me?

The 10,000 children treated at the Alex every year for minor conditions will continue to be seen by the emergency centre either within the GP led urgent care centre or PAU if required.

There are 1,200 ambulances which arrive at the Alex with the sickest children, which in future will go to the Worcestershire Royal for expert advice and assessment. This equates to an average of about three a day.

Community services will be improved so there will be more use of community children’s nurses to provide care in children’s own home or location and to ensure they can be discharged as quickly as possible.

Why change?

There are difficulties recruiting middle grade doctors, despite efforts to recruit abroad, with gaps at both sites being filled by locums.

The current service only meets seven of the ten standards set out in the Royal College of Paediatric and Child Health Facing the Future document, seen as the blueprint for future provision.

The lack of an adequately skilled workforce means in future the quality of the service is likely to deteriorate.

Maternity services

What’s changing?

The consultant-led maternity unit will be centralised into Worcester but the changes will only take place once capacity is available in Worcester and in Birmingham to ensure women have a choice, which could take two to three years to implement.

A recommendation has been made for commissioners to consider creating a midwife-led unit at either the Alex or the Princess of Wales in Bromsgrove.

A maternity assessment and day case centre should also be created at the Alex to provide pre and post birth care.

The Trust has also been told to look at working with other providers to offer the opportunity to provide antenatal and postnatal care from the Alex, even if they are booked to deliver elsewhere.

What does this mean for me?

Women with complex conditions, such as diabetes or pre-eclampsia, will not be able to give birth at the Alex but will have to travel to Birmingham or Worcester. If the midwife-led unit is created, women deemed low risk could potentially give birth at the Alex and would be transferred to one of the major centres in the event of complications.

The creation of a maternity assessment and day case centre would mean scans, antenatal clinics etc would be delivered locally.

If other providers are allowed to deliver antenatal and postnatal care at the Alex it would mean women could have their baby in Birmingham or Warwick, for example, but have their check-up, scans etc carried out in Redditch.

Why change?

Without inpatient paediatrics it is not safe to have a consultant-led maternity unit.

There are difficulties recruiting middle grade doctors with locums filling the gap and the Trust cannot meet the recommended level of consultant cover of 60 hours at the Alex - currently only 40 hours - and 98 at Worcester - currently 60 hours.

The West Midlands Deanery has also expressed concern about the lack of training experience at the Alex and has warned it may withdraw middle grade trainees in future.

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