Debbie Fleming: Merger delay could jeopardise plans to upgrade hospitals

“At the moment there is £147 million out there with our name on it,” she says. “It’s Treasury cash not PFI money which means we don’t have to pay it back. It would be devastating if Dorset were to lose that money because of delays to these plans.”

Her worry is echoed by the hospitals’ new joint board chair, David Moss, who adds: “There’s been this judicial review and possible appeal and if the matter is referred to the Independent Panel (at the Department for Health) I think they will support our case as they have supported every case of that kind in the past few years.”

However, he says, regarding the delays, which include a failed judicial review by campaigners against the downgrading of Poole’s A&E and referrals by councillors at Poole and Dorset to the Department; “It’s just a question that we want to make sure we get that money. We live in uncertain times - it could be hijacked for something else.”

The pair were giving their first joint interview, to set out the journey ahead for the proposed merger and discuss a range of issues, including the news that Bournemouth won’t get its new Emergency Department for at least four years. They also talked about the future of cancer care in the east of the county and why Poole Hospital will still see around 50,000 people through the doors of its Urgent Treatment Centre every year.

Their main concern is the ‘misunderstandings’ regarding the way care is currently organised and delivered in Dorset and the vital need for change.

The reason for the merger, says Debbie, is because care has changed, along with the requirements of patients. “If you were designing a system in this area from new, you wouldn’t have two general hospitals like this so close together,” she says. “You would do things very differently.”

She explains that numerous reports – both in the UK and abroad – as well as the NHS’s recently-published Long Term Plan show that specialised treatment concentrated on fewer sites, similar to the system in London, produces better outcomes for patients because it means they are under the care of a specialist immediately.

As an example this will mean that stroke emergencies should get access to consultant care 24/7 which ramps up patients’ chances of making a better recovery, rather than simply surviving but with significant impairment. “You don’t just want to be seen, you want access to skilled professionals, quick assessment and the standardised treatment that will maximise your chances,” says Debbie.

However, her immediate focus is not the merger as such but ‘around the workforce challenges’, of maintaining a 24/7, seven days a week high-standard service, especially in the Emergency Departments. Put bluntly: “We cannot staff the two EDs round the clock with consultants. We have 13 here and others at Poole but when we are together we’ll be able to do that.”

Although it will take around four years to organise and build the new ED at Bournemouth – so patients who use Poole will see little immediate change – the process of change has already started.

They’ve dropped the ‘Accident’ part of A&E because: “We need people to understand that they will only go to ED if it’s an actual emergency,” says Debbie.

And patients arriving at Bournemouth’s ED will have noticed the ‘bouncer’ nurse, who makes quick assessments and helps direct them to the ED or to other hospital services better able to assist them, including in-house GPs or even the pharmacy.

Going forward, says Debbie, Bournemouth will treat all major emergencies, such as severely broken bones, heart trauma and people unable to breathe.

But it will also have its own Urgent Treatment Centre, like the one planned for Poole, which is expected to receive up to 50,000 visits a year. “Put simply, if you had a non-complicated broken arm in the west of our area you’d go to Poole, but if your legs were crushed very badly you’d go to Bournemouth,” she says.

The decision about where you’ll be treated will be made either by a GP or paramedics – as it is now - with most heart and other serious trauma being brought straight to Bournemouth, whether the patient is coming from Purbeck or Pokesdown. “For people living in the west of our area, if you have an aortic aneurysm you will be brought straight to Bournemouth now, much the same as if you had severe burns you’d probably go straight to Oddstock near Salisbury. If you were able to walk into Poole’s ED now for treatment you’d probably be able to walk into their UTC with the same thing in future.”

One of the important benefits of this will be that far more people who arrive will get consultant care. “At the moment around 13,000 people who arrive in the ED see a junior doctor,” says Debbie.

Maternity will move to Bournemouth which will get its new unit, and services have already commenced, to assist this process. Dorset mums already have access to a Labour Line for mums who fear they are about to give birth, where qualified midwives will direct parents or call the appropriate services, whether that’s a flying squad midwife, a paramedic or even the air ambulance.

The ability to land the air ambulance on the helipad at Bournemouth – there is no facility at the crowded Poole site – is one of the major reasons Bournemouth was chosen to host the ED and maternity care.

Another thing the merger intends to do is slash the number of ambulance trips across the conurbation as patients are transferred from Poole to Bournemouth and vice versa each day. This, and the recently-announced additional paramedics and ambulances for South Western Ambulance will help free-up vehicles and teams, says Debbie.

And, she says, the merger will also result in fewer elective procedures being cancelled because Poole staff will not have to take patients with major trauma which often Hoovers up beds and intensive care capacity.

As a Dorset resident – along with David Moss – she feels proud of the ‘Dorset system’ which is, she says, admired elsewhere in the NHS. She believes staff are proud, too.

“I think the staff see the benefits of the merger and they do feel positive about it,” she says. “But if the uncertainty drags on it doesn’t help with our recruiting for the future. People naturally want to know what they’ll be doing and on which site.”

To that end both she and David are keen to meet groups such as DDNHS, to answer their questions and help explain why the new moves are so important and to include patients in designing the new services.

“I do have a lot of sympathy with the fact that people are worried but a lot of the time, when we are able to get into proper conversation about the way things are organised now, the need to make changes and we hear their concerns, we find that people do understand and become less anxious,” she says. “I am really troubled when I hear that people are frightened of this change.”