Briefing on the Rochdale story
James Radcliffe 07/3/12
Background
The story of what happened when Rochdale lost it’s A+E department is an
interesting example of what can happen in practice once services are
centralised.
1. Initial proposals for service changes in Rochdale:
Between 2003 and 2005 a series of meetings and discussions led to the
publication of two documents proposing profound service changes in Rochdale and
the wider North East Manchester Area. These documents are ‘Healthy Futures’ –
which concerns services in the Rochdale area, and ‘making it better’ which
concerns maternity and neo-natal care in the wider greater Manchester
area.
Healthy Futures:
Under the preferred option (which became the adopted policy) Rochdale
infirmary stood to lose it’s A+E department, ability to perform emergency
surgery, and acute medicine. It was also proposed that Rochdale should become a
centre of excellence for Cardiology. Rochdale PCT denied this was ‘downgrading’,
and said the A+E department would become an ‘Urgent care centre’
Making It Better
This was a review of maternity and children’s health services in Greater
Manchester that proposed closing several units and concentrating services across
a number of specialist sites. One of the proposed closures was maternity
services.
Both sets of proposals went out to public consultation between Jan and
April 2006.
2. Opposition to changes
There was widespread opposition within Manchester, and in particular
Rochdale, to the proposed changes. The local authority (Rochdale borough
council) commissioned Dr Sally Ruane of the health policy unit in De Montfort
University to provide an independent report regarding the changes. Her
conclusions were that there was no evidence to support the changes, the
proposals had failed to take into account levels of deprivation in Rochdale, and
had failed to apply equality criteria correctly.
An independent review panel, however found in favour of the changes, and
the various health authorities started to draw up plans. A new consultation was
launched in 2008, where the proposed changes were only given minor attention
within a more general consultation focusing on public health measures and
primary care. This masked the fact that the real intention was to continue with
plans for centralisation.
3. Closures happen and replacement services do not materialise
It was only in 2010 that the implementation of changes started to begin
(although some aspects concerning the failure to recruit of staff had already
been happening). In a political move familiar to us, labour’s candidate for the
2010 general election – Simon Danzcuk – put out a leaflet accusing his lib dem
opponent (incumbent MP Paul Rowan) of ‘scaremongering’ when he claimed
(accurately) the A+E department will close. This was despite plans being already
known for several years.
In June 2010 Pennine Accute Hospitals Trust (PAHT) announced that the A+E
department at Rochdale infirmary was to close at night – staff shortages were
blamed for this despite knowledge that this was the intention all along.
In November 2010 the local NHS trust announced that the proposed centre of
excellence for cardiology in Rochdale would not be developed. In announcing this
decision, it was explained that cardiology treatment requires critical care back
up, and Rochdale no longer had the support structure necessary for provision of
this service.
By December 2010, PAHT faced a severe financial challenge over the winter.
The local authority unanimously passed a vote of no confidence in PAHT and the
local NHS trust. In Jan 2011 it was announced that the A+E department and
Maternity services would close within 3 months, thus implementing the plans
drawn up years ago.
4. Consequences
Although it is too soon for a comprehensive evaluation to have been
undertaken, with full statistical analysis of the impact, there have been
several incidents that illustrate why concerns over centralisation should have
been taken more seriously:
• In June 2011 a Man died after Rochdale Infirmary staff lacked equipment
to resuscitate him during routine surgery.
• Leaflets had to be distributed in Rochdale advising people that A+E
services were no longer available in Rochdale infirmary as people kept attending
thinking they were there.
• Hospitals in East Lancashire reported an overspend due to increased
pressure on their services as a result of Rochdale’s closure.
• Routine surgery in Rochdale also had to cease due to it becoming unsafe
without backup services.
• Jobs are still at risk due to financial pressures
Conclusions
• Consultation processes in Rochdale appear to have been irrelevant to the
outcome, with decisions already taken.
• Phrases in the consultation documents are very similar – need for
sustainable services, safety being put first, no change not an option etc.
• Recruitment problems also identified as an issue, and blamed for short
term closures instead of coming clean and stating recruitment problems are down
to the fact services are being moved.
• Repeated financial difficulties of institutions – did not cease following
centralisation.
• The labour party accused political opponents of scaremongering prior to
an election, and closures started to happen after the election (2010).
• Senior management deny services are being downgraded – services later
close.
• Following decision being taken, community facilities fail to materialise
to reduce hospital admissions.
• Changes largely happened by stealth and slowly
• If they couldn’t make the ‘specialist centre/community health’ model work
in an urban area like Manchester, how on earth can we expect them to make it
work in a Rural area or an area with poor transport where the model is
particularly inappropriate?
https://www.assemblywales.org/epetition-list-of-signatories.htm?pet_id=805
that trains doctors wants them to get enough experience in their training. This has led to doctors increasingly wanting to train in centres of excellence where they get enough cases to deal with. If we don’t re-configure services in Wales, we’ll struggle to recruit in the future.
