If you have a child who regularly attends planned appointments at Poole it is likely that this will remain the case, however we are unable to confirm without knowing more details. The planned hospital will still be the site of Children’s therapies and outpatients appointments and our proposals for care closer to home will be supported by GPs with special interest in paediatrics and maternity which will mean less travel for many. As has been well documented, consultant-led maternity and paediatric services will be based at the Major Emergency Hospital (Royal Bournemouth Hospital) with national evidence supporting this model and showing that having specialist sites will save lives. Please be assured that the changes are made over the next five years and during this time we will continue to work with key stakeholders, including members of the public to look at how these services will move.
The South West Ambulance Service Trust (SWAST) report concluded that if the CSR proposals were implemented, the average emergency journey times would remain similar to those undertaken at present and for many patients, journey times would be shorter. In addition, there would be a large reduction in patient transfers between hospitals in East Dorset and this would improve journey times and patient safety.
The CCG will plan to commission the required ambulance services to meet the expected demand at each site as noted in the ambulance service report. As detailed plans emerge on the future of which site will deal with which condition, more will be known about additional resources. Our workforce group is working with the providers to increase recruitment and retention in Dorset for groups like paramedics and are already identifying the future workforce requirements. As our work moves forward we will continue to engage with patients and relevant stakeholders, and update members of the public.
At present there are no proposals to change the provision of the air ambulance services. The emergency response vehicles and type of staff required will be met by the ambulance service and it will be down to them to decide which is the best method for ensuring safe travel. Initial discussions do not suggest an additional air ambulance would be required, however as the plans progress this will continue to be reviewed by the service.
The majority of emergency cases currently treated at Poole Hospital’s A&E department would continue to be treated in Poole at the 24 hour Urgent Care Centre.
More severe and life-threatening cases would be treated at the major emergency hospital in Bournemouth, including loss of consciousness and serious accidents.
The Urgent Care Centre will be able to accept and treat under 16s, depending on the nature of the condition but there may be instances where a transfer to the major emergency hospital is necessary (even with non-life threatening injuries). Specialist 24/7 consultant delivered in-patient paediatric services will be located at the major emergency hospital and will be able to provide support through a network of clinical services across the county.
As part of the public consultation we asked for views on the site of the Major Planned and Major Emergency Hospitals. Overall, there was support for our Option B (Poole Hospital as the major planned care hospital and Royal Bournemouth Hospital as the Major Emergency hospital). Responses to the open questionnaire were 34% in favour of option A and 44% in support of option B (22% of people had no preference).
During our deliberation phase, we gave careful consideration to both Option A and B taking account of the full consultation responses, including the petitions, and the additional work undertaken. We concluded that there is no new evidence that would suggest a change to our preferred option for implementation, which remains Option B.
The CCG received and noted the petitions submitted and the petitions were included in ORS’s report. In interpreting and reporting them, ORS took account of the ‘petition statements’, the numbers of people signing, and the ways in which they were compiled. Dorset CCG Governing Body considered the consultation report and its findings, including the petitions, in full.
ORS’s guidance regarding petitions notes that petitions can exaggerate general public sentiments if organised by motivated opponents but they should not be disregarded, for they show local feelings; these observations do not discredit the petitions, but provide a context within which they should be interpreted.
It should be noted that a consultation is not a popular vote; and influencing public policy through consultation is not simply a numbers game in which the loudest voices or the greatest numbers automatically determine the outcome. Interpreting the overall meaning and implications of consultations is neither straightforward nor just numerical, all the various consultation methods have to be assessed.
Accountability means that public authorities should give an account of their plans and take into account public views: they should conduct fair and accessible consultation while reporting the outcomes openly and considering them fully.
This does not mean that the majority views should automatically decide public policy; and the popularity or unpopularity of draft proposals should not displace professional and political judgement about what is the right or best decision in the circumstances.
The levels of public support and the reasons for opposition are very important, however considerations need to be taken into account, and are not necessarily factors that determine authorities’ decisions.
For the CCG considering the outcomes of consultation, the key question is not: which proposal has most support but, are the reasons for the popularity or unpopularity of the proposals cogent?
In this context, we encouraged all respondents to the consultation including people who signed a petition to also complete the open questionnaire as this was the best way to provide supporting information or evidence that might cause the CCG to review the CSR proposals.
We appreciate that people have been particularly concerned about both emergency and nonemergency transport and we have received and responded to a number of queries regarding transport. As a result, we worked with South Western Ambulance Service NHS Foundation Trust (SWAST) and transport leads from the three local authorities (Bournemouth, Poole and Dorset) to review the travel times, data and approach that was developed within the CSR design phase.
SWAST undertook modelling based on the proposed options to ascertain whether they could continue to deliver a safe service following implementation of the CSR. The modelling concluded with a report offering assurance on the proposals. The ambulance service has undertaken detailed work to better understand the likely impact of the hospital changes within Dorset. The model developed showed that the average journey time to hospital remained very similar to what it is now. For many patients, the journey to hospital will either be the same or even quicker. Some patients will have to travel further to a specialist centre, in order to get the best possible care. Given the rural nature of the County of Dorset, paramedics are experienced at safely transporting patients for longer distances to hospital.
Adrian South, Clinical Director for SWAST has said “I’ve looked closely at how these plans might affect ambulance services in Dorset and how they might affect patients and I’m confident that the plans will improve emergency care by allowing the ambulance service to take patients safely and quickly to the best hospital where they will receive the best care. We will also reduce transfers of patients between hospitals, instead they should go to the right hospital from the start.”
We hope that this report reassures people that these proposals are designed to ensure that people get the best possible care and that we are focusing on getting the best outcomes for people in Dorset using these services in future. This report demonstrates that, through public consultation, we have listened to those people who expressed their concerns about having to travel further or for longer to get emergency care.
The Local Authorities focussed on non-emergency travel times. Transport planning leads were also able to independently assure our travel times and approach and present their findings within a report.
The resulting analysis indicates that CSR travel times are within similar and acceptable parameters to the routing software and analytical tools used in local authority transport planning activities. The results were found to be consistent across all travel comparators for acute and community based healthcare services. Sense checks on the results using digital mapping confirm that the travel times used are a reasonable approximation from which to draw conclusions for travel associated with the CSR proposals.
A Transport Reference Group has been established to develop joint transport plans in support of a system-wide Integrated Transport Programme of work. This programme is a collaboration between health, local authorities and community and voluntary services.
We will continue to work closely with SWAST and the local authorities to ensure we address the implementation requirements and needs of the CSR.
Please be assured that the changes will be made over the next five years and during this time we will continue to work with key stakeholders, including members of the public to look at how these services will move.
Whilst we do of course welcome the one-off investment of around £147m into Dorset we are still facing a potential funding gap of £158m every year from 2021 which is when we anticipate the changes will be in place.