DCH crisis - patient care (From Bournemouth Echo)

DCH crisis - patient care

9:10am Thursday 5th November 2009 in

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ECHO: Will the Special Care Baby Unit close? DEREK SMITH: The baby unit is safe, but we are going to look in the short term about joining the children’s service with others to make sure that it is safe. We will look at working with another hospital to make sure we have a bigger critical mass and a bigger pool of experienced professionals and that the service can be provided on a secure basis for the local population.

Here we are very fortunate because we do have the right kind of medical cover for children. The question is whether over time, and I’m talking five to 10 years, that can be sustained.

So, will there be a reduction in paediatric workers? No, we want to secure the paediatric service here but we have to make sure we do it in such a way that it is sustainable and ultimately affordable as well.

People have been saying for years that the elderly care provision at DCH is not good enough. Is there a problem with elderly care? Overall I don’t think there is. There is a very strong focus in the hospital on elderly care and in fact the majority of the patients who come into our emergency medical service are elderly. Part of the core of that service is that we have a team of specialists in the health care of the elderly – doctors which, in spite of financial difficulty, we have agreed to increase in number to five.

Will the staffing cuts make any impact on elderly care? We will certainly not be affecting adversely the service we provide in the hospital for elderly people. The question that we have to address is if we are able to provide so many clinics in community hospitals for local access. One of the issues we have identified is that when our vital clinical staff are providing clinics elsewhere, they are not here.

So there may be some instances where we consolidate the services we provide on the hospital site other than to have them quite so widely spread as we do at the moment.

That will be to secure the quality of the care in this site more than to make a saving, although it is true to say that more patients will be able to be seen here. Of course there will be an effect on patients where they might have to travel further to get the service.

What effect has the new EU working regulations had on the hospital? We have had to increase our junior doctors by about 30 per cent in number. It means that the junior doctors can no longer work more than the requisite hours specified and effectively they are working shifts. They used to work a lot more hours and of course the argument then was that they worked too many hours and got too tired, which could impair their judgement, and that was not good for patients. Now the issue is about the amount of exposure they get clinically and how much experience they can get and how quickly they can get it.

There is also the issue of the quality of the handover from doctor to doctor because clearly if you are working shifts then you have to properly be able to hand your shift over to the next person.

Have other hospitals faced financial restraints because of this? Well, everyone has had to spend more money but not everyone has got themselves into the deficit as this hospital has.

Will there be any changes for cancer suffers visiting the oncology ward? I would certainly say that cancer chemotherapy has a long-term future at this hospital. It is a very necessary and appropriate service that is offered locally and people need a local service. Now the chemotherapy service is mainly for outpatients and for the people receiving it on a daily basis. The cancer centre is at Poole so we have to question the extent to which we are providing support for in-patient cancer patients.

A great deal of specialist cancer surgery takes place elsewhere although we do treat the most common cancers here such as colo-rectal and breast, which may be entirely appropriate. The question is whether we should be treating, for example, blood cancer care as in-patients. Should they go to somewhere like Poole as in-patients and then be treated here as out-patients and receive their chemotherapy here?

Is that change for patient care or a cost-saving measure? It is a thing we need to review at the moment. It’s whether we can provide that care appropriately. Because we are doing it in relatively low numbers, are we providing it cost-effectively as well? The question is just how much cancer treatment should we deal with here in the longer term.

What other wards are being scrutinised as part of the cost-saving consultation? We need to ask questions about the amount of very specialised cardiology that we do here.

The hospital has a good cardiology department and it is providing a service to patients who not only have heart problems that can be treated on a planned basis but also heart failure. This can now be treated interventionally by putting in stents, which is a very successful treatment. We have to ask ourselves to what extent we can continue to do that. They are all expensive areas and need to be looked at.

With all these consultations will you need to look to see if neighbouring hospitals Poole and Yeovil have the extra provision? We know for that service Bournemouth provides it on a 24/7 basis but Bournemouth is a long way away. At the moment we are providing a much more local service and we just need to satisfy ourselves that it is appropriate.

What other specific departments are you looking at changing? Some of the more specialised area of surgeries. We need to decide whether to provide them or not and whether we can do so sensibly.

What other services are you looking at getting rid of? We are looking at all departments, the facilities, estates, administrative staff – literally looking across the board.

How do you go around balancing the need for cleanliness and more staff in the days of norovirus and MRSA and having to cut staff? We have to work out where we can make reductions without having a drastically adverse affect on the service.

We need to keep checking that we haven’t got that wrong.