Concerns over hospital changes

The district council's overview and scrutiny committee will be asked on Monday to gather members' views so the cabinet can form a response to public consultation on the future of the NHS locally.

The chief executive has produced a summary of the issues for the guidance of councillors together with his assessment of the issues that affect Rother residents.

He warns that while the interests of people in Hastings and Eastbourne are being represented by "vocal campaigns," there is a risk that the voice of people in Rother will not be heard so forcefully.

At issue is the future of maternity care.

The proposals for change are based on evolving social and economic factors:

*The population profile is "ageing";

*Numbers of women of childbearing age are falling;

*Long-term health conditions, such as diabetes, are becoming more common;

*Healthcare is changing, becoming more specialised;

*Mothers' expectations are changing;

*Technology, new drugs and improved surgery are improving health outcomes; and

*Primary and community care are relieving dependence on hospitals.

The chief executive says: "The full details of the current maternity service are set out in the PCT document. In short, the majority of Rother residents currently access maternity, gynaecology and neonatal services from the Conquest Hospital, Hastings, Pembury Hospital, Tunbridge Wells, Crowborough Birthing Unit or the DGH at Eastbourne.

"The reasons given for the need to change, in addition to the factors outlined above, are:

'¢Specialist Skills - Units with a higher number of births (2,500+) are likely to be better skilled and equipped at dealing with high-risk deliveries.

'¢Choice - Evidence suggests that significantly more women would like the option of home births or midwife-led services with minimum intervention.

'¢Working Time Directive - There is a requirement to cut junior doctors hours of work and therefore pressure to employ more staff. A single hospital site for consultant-led care would mean that doctors would be fully deployed..."

Four options have been put forward by the Primary Care Trusts.

The chief executive says: "It should be noted that the PCTs have emphasised that they support a vision where the two hospitals in Hastings and Eastbourne have 'a strong and viable future'.

"They have undertaken to retain emergency care at both hospitals, the subject of an intensive protest campaign of action last year.

"The PCTs maintain that finance is not the main driver for the proposed changes. However, financial pressures on the NHS as a whole mean that there is a continuing need to find savings and build sustainable solutions to healthcare across the country.

"Preventing future PCT deficits is clearly part of their brief.

"An alternative proposal has been developed by the Save the DGH and Hands Off the Conquest campaign groups that aims to show that a medium risk consultant led service can be retained in both hospitals, with a high risk unit and neonatal care unit being developed for the region at Brighton.

"This option has been accepted into the consultative process and is being evaluated independently."

Summarising "considerations for Rother residents" Mr Stevens says: "The key consideration, stressed by all parties involved in the consultation, is of course the safety of mothers and babies.

"It is argued by some that units that are too small to accrue experience in high-risk deliveries and that do not have the specialised equipment of a larger unit can jeopardise this safety.

"Others argue that safety can be compromised by longer travel times for mothers in labour, particularly those requiring an emergency Caesarean.

"A further factor has to be the convenience of travel times.

"Whilst the PCT document looks at journey times based on off-peak travel by private car, it would seem that the estimated times for arrival at Eastbourne DGH are at best optimistic for those living in rural Rother.

"There is a view that Option 1, which proposes no unit at all at Hastings, would seriously inconvenience the maternity care of Rother mothers."

Referring to a consultation appendix showing the numbers of births at local hospitals, he says: " It is worth noting that the PCTs' recommendations are based on a forecast fall of some 8% in the number of new babies born in the county, based on County Council population estimates."

He concludes: "The key question at the heart of the maternity services consultation seems to be whether centralised, larger delivery units will offer safer, better, more efficient outcomes than the provision of smaller, more local units.

"There are clearly cases to be made on both sides of the argument. As community leaders, it is for members to take a view where the best interests of Rother residents lie, now and in the future, and to promote the appropriate course of action."

In a risk assessment, the chief executive says: "It is important that the council contributes to the debate on maternity services in the county so that the voices of Rother residents can be heard.

"There is a risk that whilst the interests of those in Eastbourne and Hastings are represented by vocal campaigns, those in Rother, particularly those in rural areas, may not be so well heard.

"These are the very communities likely to be most hard hit by a decrease in service or increases in journey times."