Friarage Hospital: critical moment for emergency services

I entirely share your concern about the recent announcement about critical care services at our local hospital, the Friarage in Northallerton.

Like you, my family rely on and care deeply about the Friarage. From fixing broken bones to treating allergic reactions, the doctors and nurses at the hospital have been there for us, just like they have for thousands of local families. And since being elected as your Member of Parliament, my highest priority has been to ensure the Friarage remains a strong local hospital.

So this announcement is extremely disappointing to me personally.

It is also very frustrating that this change has been sprung on us by the South Tees Hospital NHS Foundation Trust in such a sudden way. Frustrating because this change is not driven primarily by money, but by recruitment and staffing issues that have been known about for a long time.

Indeed, I have been pressing the Trust on this specific issue for well over a year, following a meeting I organised with local medical staff in 2017 to discuss recruitment in detail.

The Trust have said they made this sudden decision because they believe it is the only way to secure patient safety. As a layperson, it is difficult for me to argue they are wrong, and indeed our local GPs and medical staff appear to be supportive of the Trust’s decision.

In order to help people really understand this decision over our much-valued local hospital, as you may have seen, I organised a public meeting with senior decision makers from the Trust/Hospital. It was attended by the Deputy Chief Executive of the South Tees Trust, Dr Adrian Clements, who is also the Friarage’s overall Director, and Dr James Dunbar the Friarage’s clinical director, responsible for what the hospital delivers on the ground.

It is vitally important, in my view, that those making these decisions are accountable for them.  And the meeting also allowed us as a community to demonstrate our strength of feeling on this issue.

What is clear is that the issue here is not financial resources, but persuading a handful of relevant critical care and anaesthesia doctors to work at the Friarage.

Following my representations, the Trust agreed to review and improve its recruitment procedures, including widening its net to seek talent from overseas. Additionally, I identified a specialist doctor recruitment agency to help and also suggested the Trust use incentives to encourage doctors based at the James Cook University Hospital in Middlesbrough to cover the Friarage rotas. Regrettably these measures have not solved the problem.

There is a larger pool of around 50 anaesthetists and 16 Critical Care consultants at the James Cook, some of whom have been informally helping the Friarage for the past few months. I am grateful to them, especially as I recognise the pressures they face in Middlesbrough. 

As many of you have suggested to me, I have consistently pushed the Trust to find ways to share these doctors permanently across both the James Cook and Friarage sites, given that they are part of the same Trust. I have been told that the doctors have been offered substantial incentives to work at the Friarage permanently but have chosen not to accept. I have also been told that that the Trust cannot contractually roster these doctors to work permanently across both sites.

A large part of the reason for this has to do with changes in clinical guidance from the Royal College of Emergency Medicine which requires more specialist emergency care consultants to work in critical care wards.

Historically however, the Friarge has been staffed with more generalist consultants who provide both anaesthesia and critical care. A handful of our flexible generalist consultants, essential for our small hospital, are now retiring.

There is a larger pool of these generalist anaesthesia consultants at the James Cook but it is hard to persuade them to cover critical care at the Friarage as they feel that this is more appropriately done by specialists, given the evolution of medical training and guidance from their Royal College.

And then the specialist critical care doctors prefer to work at larger hospitals like the James Cook where there is much higher activity in their chosen specialty compared to the very low volumes of this kind of work at the Friarage.

And that in essence is the problem. Money is not the primary issue. In fact, it has been confirmed to me that the new model will actually cost £1.7 million more to run each year. Finding what amounts to around a handful of specific doctors to work at the Friarage is the issue.

Going forward I am continuing to meet the Trust’s senior managers and staff about their permanent plans for the hospital.

I have also personally hired a leading healthcare consultancy to provide us with independent advice. I have asked them to carry out a comprehensive review of how emergency care provision is done in other hospitals like ours. I want us to have objective, credible evidence and demonstrable alternatives which we can take to the Trust to bolster our case.

Obviously, my priority is to find a way to maintain our current A&E provision. But as I hope I have clearly explained, there is no easy way to do this, nor is it within my control.  

To solve this problem sustainably, the Trust needs to find or persuade a handful of extra critical care doctors to permanently work at the Friarage - the funds are there to pay them if they are willing to work here, but the local medical community believes it will not be possible to sustainably and safely staff the critical care unit for the reasons outlined above.

My understanding from the Trust is that even with the proposed temporary changes, around 9 out of 10 patients who currently use emergency services at the Friarage will still be able to do so.   

But if these temporary arrangements do become permanent, there are several specific areas where I will be fighting on behalf of my constituents:

1)      I will be arguing for as much additional work to be done at the Friarage as possible. For example, I am pushing for more planned surgery (like short stay and day surgery cases) and outpatient appointments to be carried out at the Friarage, saving many of you a trip to the James Cook for these visits or a shorter wait for your appointment.

2)     I would want the 24/7 Urgent Treatment Centre to treat ill children as well as adults as the current A&E does not the full range of sick children. I know this is something many young families would welcome.

3)     I have successfully pushed the Trust to make the Urgent Treatment Centre open 24/7 rather than for only 12 hours, which is what they originally had planned. I will fight for 24/7 access to be maintained if these temporary arrangements become permanent.

4)     I shall also press for patients who may have to be admitted to the James Cook hospital at a critical stage in their treatment to be returned to the Friarage if they require a longer stay in hospital.

5)     I am talking to the Yorkshire Ambulance Service about issues around the safe transport of critically-ill patients to the James Cook from the more remote parts of the constituency, like the Dales.

6)     I shall be doing my best to support the staff affected by the changes. I have been assured by the Trust that there are no planned redundancies and that the staff – mainly critical care nurses - who may be asked to transfer to James Cook will have their terms and conditions protected. They could also be compensated for the move by the Trust. For those nurses for whom such a move is not practical or desirable, I am exploring ways they could receive any training required to remain at the Friarage in a different capacity. The new UTC will require a greater number of skilled nurse practioners for example.

Lastly, to quell any rumours, I have successfully sought assurances that the MRI scanner which you and the wonderful Friends of the Friarage worked so hard for will not be moved to James Cook. It is staying at the Friarage, as it should. Also, it has been confirmed to me by the chief executive of the Yorkshire Ambulance Service, that two additional ambulances will serve the area to transport the eight patients a day affected by the change to the James Cook.

I will continue to fight for an outcome which ensures a sustainable future for our much-loved local hospital. While I am not a medical professional, the NHS is in my blood. Both my parents dedicated their working lives to the health service and I am completely committed to ensuring your family can rely on the best possible hospital services locally.

Thank you for writing to me on this vital matter. Please do not hesitate to contact me if you have further questions or ideas and information that might help me make our case.