Last week I shared ten key questions for the NHS Trust about their proposed changes for Furness General Hospital and I can now share the answers that I’ve had back. I have published the answers below, in full.

There are still many areas of concern particularly for me that Gynaecology would not be in a same-sex ward, the loss of single rooms, and the impact that the loss of Abbey View would have.

The Trust have told me that nothing has been decided and that after they have finished their consultation with their staff members in the new year then they will publish updated proposals and at that stage they will decide if public consultation is needed.

I hope that once they have reviewed the feedback from their staff and amended the proposals they will ensure the public has a proper opportunity to feed back its view – not just though the Health and Adult Scrutiny Committee but though wider public engagement.

It is vital that local people are fully involved in this process – the NHS makes its best decisions when it properly listens to the views of those who use it services.

The full answers received from University Hospitals Morecambe Bay NHS Foundation Trust in response to questions asked about the planned bed reconfiguration for Furness General Hospital.

Changes to Ward 1 – Gynaecology Unit

QUESTION ASKED: Please can you confirm that the Gynaecology Ward will now no longer be single-sex but that there will be single-sex bays within a mixed ward? Has any risk-assessment been carried out on this approach, and can it be published?

UHMBT RESPONSE: If the proposals are accepted as they are now, then Gynaecology inpatients would be in a dedicated area within Ward 5. Ward 5 is made up of single sex bays where patients do not share a bay or facilities with members of the opposite sex.

A full QIA (Quality Impact Assessment) and EIA (Equality Impact Assessment) has been completed for these changes which I believe we have shared with you. These are clear that any changes must not compromise the privacy and dignity of women. I’d like to be clear – if we cannot protect the privacy and dignity of our patients, the changes will not go ahead.

QUESTION ASKED: Some of your patients have resident babies on ward 1 which means that it must be locked at all times. Can you tell us how this will happen on a main surgical ward?

UHMBT RESPONSE: This would be risk assessed on a case-by-case basis at the time as this is a situation that happens very infrequently and not just on Ward 1. Generally, in this situation, we recommend a supportive partner present and a single room. This is the same as we would for a woman with a baby needing treatment on any other ward.

QUESTION ASKED: Many women are in Ward 1 after miscarrying in their second trimester. It is important that those women who want to will be able to spend time with their baby after delivery and at the moment that can happen with the provision of a cold cot. Can you describe how that would happen under your new arrangements?

UHMBT RESPONSE: The proposed plan includes developing a female section of Ward 5 – segregated from the rest of the ward and including a private room. In the sad scenario you outlined, there are options available. For losses above 16 weeks’ gestation, women would be cared for and supported within the dedicated bereavement suite within South Lakes Birth Centre. For losses under 16 weeks, women could be cared for within the private room on Ward 5 or the bereavement suite within South Lakes Birth Centre. All options would include the use of the cold cot should the family wish to do so.

Single rooms

QUESTION ASKED: The plan seems to suggest that there will be a significant reduction of single rooms. Can you confirm the number? What plans are in place for increased infection in patients during the winter months in light of this?

UHMBT RESPONSE: Ensuring our patients and colleagues are protected from winter illnesses as much as possible whilst with us is very important, and something that we will continue to focus on when making any changes.

The current provision of single rooms at FGH is 69 beds out of 268 which equates to 26% (includes all speciality beds). Using the information provided in the consultation document, the proposals will reduce provision of single rooms to 50 out of 215 which equates to 23%. This is an overall reduction of 19 side rooms and a reduction of overall single room capacity by 27%.

Current data suggests that the peak of winter infections is likely to be in the next two to three weeks and we do not intend to make any changes to the bed configuration at FGH during this time. That said, we are continuing to work with our experienced Infection Prevention and Control colleagues to ensure that we can maintain the safety of patients and colleagues going forward in any changes that may be made.

Abbey View

QUESTION ASKED: I know that the amazing staff at Abbey View provide a range of care and the concern is that this cannot be done in the community.  Many Abbey View patients require 24hour Nursing care overseen by doctors with lots requiring intensive ‘end of life care’ and others are post-op, many have delirium and infections. Can you please share your assessment of how this care can be provided safely in the community?

UHMBT RESPONSE:Abbey View is a community bed unit. It is not a palliative care ward – and although there is excellent end of life facilities on the ward – and we will need to ensure that sensitively these are re-provided should the ward close – it is not the best place for patients in their final days.

It is also not an acute medical ward nor a surgical ward. Our package of proposed changes is designed so that:

• Medical patients requiring acute care are cared for on medical wards, with doctors able to provide care 24 hours a day adjacent to other medical patients
• Surgical patients are cared for on a surgical ward, with easy access to specialist consultant surgical care, not a community unit separate from the main hospital site.
• Surgical beds are ring-fenced and dedicated for surgical patients only

Care has moved on since the Abbey View model was designed many years ago, and rather than languishing in a hospital bed, it is better for patients to either receive enhanced community support to enable them to remain well longer, or receive acute care and then move to an intermediate care facility such as Park View Gardens where they will receive specialist reablement to allow them to return home more quickly.

The Wellness Model of Care that we have developed locally in partnership with the Westmorland and Furness Council and plan to launch in the new year, is designed to help prevent people being admitted to hospital, help them recover more quickly and enable them to receive care close to or at home rather than spending a large proportion of their final days in a hospital bed.

QUESTION ASKED: What will the impact be of closing Abbey View during winter pressures – will you share your impact assessment on A&E of reducing step-down beds at the period of highest demand? Is this not the worse time of year to be implementing this plan?

UHMBT RESPONSE: For this seasonal winter, Abbey View will remain in status quo with no changes. From next seasonal winter onwards, we are confident that the impact of the Wellness Model will be benefitting patients who previously would have found themselves in Abbey View for long periods of time not meeting the medical criteria to reside; and those patients who ideally would have gone to intermediate care rather than Abbey View will be going directly to the excellent facility at Park View Gardens.

Park View Gardens

QUESTION ASKED: Your plans are very reliant on those who are “Not Meeting the Medical Criteria to Reside” using the facility at Park View Gardens with patients that would current be seen at Abbey View and the Gynaecology Ward (and presumably others) being moved there. Can you please confirm how many extra beds in total there will be at Park View Gardens and what medical support and staffing is available there?

UHMBT RESPONSE: The Intermediate Care facility at Park View Gardens is specifically established to support reablement for our residents – to protect and promote independence. Not everyone who has concluded their consultant-led care episode but remains in hospital is suitable for Intermediate Care – this is a clinically or care professional led decision. If patients require care and support that can only be provided within the hospital, they will remain in the appropriate medical or surgical ward.

Intermediate Care supports people to regain or retain their independence. There are now 18 Intermediate Care Beds and six Respite care beds (full complement opened at the end of November 2024), with some ability to flex to meet residents’ needs. Intermediate Care at Park View Gardens is a joint venture with Adult Social Care and Westmorland and Furness Council who provide support staff to Care Quality Commission standards. Physiotherapy and occupational therapy input is provided by Trust staff, and medical cover for the 24 beds is provided by a Barrow GP Practice.

Future sustainability of Furness General Hospital and Westmorland General Hospital

QUESTION ASKED: These changes sit alongside other cuts to services in recent months including the downgrading of the Critical Care Unit at FGH. Does the Trust therefore recognise the dangers of undergoing this bed reconfiguration at this time? What assessments have been made as to the wider impact on the sustainability of our hospital?

UHMBT RESPONSE:I need to be clear – there are no ‘cuts’ to services in the proposals. None of the proposed changes mean that we stop providing or reduce any services for patients but may change where they are provided within the hospitals and the community.

It’s also important to point out that the recent difficult decision to temporarily limit critical care to Levels 1 and 2 at FGH is not related to the proposals to use our beds differently. They are two separate issues. The bed reconfiguration proposals are proactive plans we have put together with clinical colleagues to make change, whereas the decision re ICU was a business continuity decision taken to protect the safety of patients and colleagues.

Since the original change was made on 23 September 2024, only a very small number of patients have had to be transferred – with no cases incurring any clinical harm.

We continue to work closely with the Lancashire and South Cumbria Intensive Care Network, to do all we can to reinstate the service.

We are clear that FGH has a strong and bright future as a district general hospital with services such as urgent and emergency care, maternity, etc; and we remain committed to that. The recent announcement of significant funding for the area as part of Barrow Rising also supports this vision for the future in Barrow.

Surgical beds

QUESTION ASKED: In relation to the reduction of surgical beds, have the trust taken into account the increase in the number of patients who suffer a ‘fractured neck of femur’ in the winter months? The number of orthopaedic beds is not-sufficient and many orthopaedic patients often reside on ward 4 and 5, throughout the year,  what is the plan for these patients?

UHMBT RESPONSE: These proposals have been put together using 12 months’ worth of data and occupancy figures across all services to make sure that any changes can be made safely. This data has shown that the number of beds proposed is correct for the activity. The proposals will help ensure that patients receive the care they need in the right place – i.e. surgical patients in surgical beds receiving the specialist care they require rather than being spread across various wards.

Our Question: You say that surgical beds are going to be ring-fenced but what happens in the event of a threat of “12 hour breach” in A&E? Would surgical beds be protected in this instance?

UHMBT RESPONSE: Yes – the beds would be ring fenced. This model was tested when the Trust was in OPEL4 recently and was successful with elective admissions safeguarded despite extreme pressures.

Recruitment

QUESTION ASKED: The reduction of surgical beds is a direct threat to the recruitment of surgeons in the future. How does the trust plan to attract surgeons in the future to a surgical unit with one inpatient ward? 

UHMBT RESPONSE: We do not necessarily agree with this point as recruitment and retention of valued clinical staff is multifactorial. It is important to remember that Ward 4 (surgical ward) is currently predominantly caring for medical patients, not surgical patients. The proposed change will allow us to ring fence surgical beds and offer a better service to our patients.

QUESTION ASKED: There was supposed to be an in-depth recruitment drive for anaesthetist which would improve the sustainability of the ICU on the FGH site.  Did this happen? Is the CQC action plan for ICU still in place as the recruitment is crucial to this plan?

UHMBT RESPONSE: The recruitment and retention plan, set within a wider critical care improvement strategy has yielded early successes and is ongoing.

Consultation

QUESTION ASKED: As well as a statutory requirement for NHS bodies to formally consult with patients and the public when making significant changes to services, I am sure that you NHS makes better decisions when it properly listens to the views of patients and the public. You will have seen the significant public concerns about the proposals you are making. Can you please commit to pausing these plans whilst a proper public consultation is taken out?

UHMBT RESPONSE: I completely agree – the views of service users help to make services better. However, as we discussed with the Health Adult Scrutiny Committee, no decisions have been made and there are no final plans to ‘pause’.

It’s only right that we talk to our teams first and consult with them on proposed plans to change the way they work as per Trust policy. This is their opportunity to feed into the proposed plans moving forward; and based on the feedback we have received to date; it is likely there will be some changes to the proposals.

Once we have finalised the revised proposals, we will discuss them with our teams again to ensure we have heard correctly and made the changes required to resolve any major concerns. We will also share with our commissioners to advise on whether they believe the plans are substantial service variation and therefore, require public consultation. We will then discuss with the Furness Locality Board and HASC as agreed with the committee this week.

If the final plans hit the threshold for public consultation or a wider engagement piece of work; we will, of course, support that fully. In the meantime, most of the concerns raised by the public surrounding end of life care provision, privacy and dignity of gynaecology patients, etc, are the same themes that have come up in the colleague consultation and we aim to address those in the revised plans in the coming weeks. If we are unable to address them, the changes will not go ahead.