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October 2007 

NHS Primary Care Trust meeting

On 15 October 2007 the West Sussex County Council held one of its series of 18 meetings to discuss its response to the public consultation by the newly established NHS Primary Care Trust serving West Sussex (1) on setting up of a major general hospital and reorganising the three district general hospitals in the area at Worthing, Chichester and Brighton.

The consultation, which closes on 30 October, invites views on three Options which have been worked up with doctors, nurses and other health professionals, local authorities, voluntary groups and selected members of the public.

Option A proposes upgrading the district hospital at Worthing to a major general hospital at Worthing supported by a local general hospital at Chichester (St Richards) and a community hospital at Haywards Heath (The Princess Royal).

Option B also proposes upgrading the district hospital at Worthing to a major general hospital but supported by two local general hospitals, one at Chichester and the other at Haywards Heath   

Option C proposes upgrading the district hospital at Chichester to a major general hospital supported by a local general hospital at Worthing and a community hospital at Haywards Heath. 

The hospitals

Major general hospitals provide acute medicine, accident and emergency srevices, inpatient children’s services, emergency surgery and consultant-led hospital births to serve a population of 300,000 or more.

Note: the PCT seems to have some doubt about the true figure; it could be as high as 450,000.

Local general hospitals provide an urgent care centre, surgical beds and surgical day cases, a range of diagnostics, outpatient clinics and rehabilitation and beds for those with some special medical conditions to serve a population of 150,000 to 200,000

District general hospitals provide a range of clinical services, but not specialised services, to serve a population of about 150,000.

Community hospitals provide a minor injures unit, some diagnostics, community and rehaibilitation beds and teams odf staff from from health and social sevices working tgether to support people to live independantly to serve a population of less than 100,000.

Below these come the local hospitals, such as Horsham and Crawley, and the raft of community health and social services.

Issues summarised by the PCT speakers

First, the need to provide ‘top of the skill’ specialist consultant training and to support some specialist equipment requires the catchment area of a major general hospital

Second, the long-term intention is to provide as many services services as possible at local community level.

Third, while the PCT has to eliminate its present deficit of £100m over the next two years, the purpose of the proposed reorganisation of the hospitals is not to reduce spending but to ensure that it is distributed to the best advantage and community services have a crucial part to play.

Issue raised by questioners

The population of West Sussex is concentrated in two main areas - the coastal strip and the Horsham/Crawley conurbation. This has implications for siting only the one major general hospital proposed although, as the population of the County is some 750,000 and growing, it was suggested that, asssuming a catchment area of say 350,000, there is a case for a second presumably sited to serve the needs of the north of the County, Gatwick Airport and the M23 and M24 motorways. There is also a strong demand for access, closer than the coastal strip, to the less specialised but more frequently used services, such as maternity and accident and emergency units.

A site for a second general hopital at Pease Pottage has been proposed and the Crawley Local Development Plan also provides an alternative site west of Crawley. According to the PCT neither has been judged to be clinically sustainable, financially sustainable and deliverable but at least part of the reason seems to be that, while each PCT is responsible for the provisions in its area, it is always possible for patients to express a preference for a facility outside it and this could tend to draw patients from the Surrey hospitals which, as they have spare capacity, would be further destabilised. This seems unlikely as the Surrey hospitals are not popular with West Sussex patients or their families. Be that as it may, the PCT has indicated that it will revisit the issue when the responses to the hospital consultation are known.

The PCT has plans in hand for a second consultation on the community services such as Doctors’ Surgeries, Practice Nurses, Pharmacies and health promotion for which it is responsible, also for other services such as care in the home and other social services. The PCT also has its eye on a share of section 106 Agreement monies. This raises the issue of ‘cost-shunting’and the PCT was criticised for not combining its  hospital and community consultations.

To conclude - we were exhorted to sign the WSCC’s petition calling for the PCT’s  options to be reviewed.

Oliver Palmer

(1) Creating an NHS Fit for the Future’ West Sussex Primary Care Trust  2007