D-day for future of NHS services in north and west Cumbria

After months of campaigning from communities across the area, health chiefs will deliver their verdict on controversial plans for maternity, children's and emergency services and whether or not to close community hospital beds in Maryport, Wigton and Alston.

NHS Cumbria Clinical Commissioning Group's (CCG) governing body is due to meet at the Oval Centre in Salterbeck, Workington, at 10am today to discuss the Healthcare for the Future proposals.

These controversial options, drawn up by the Government-appointed Success Regime , include downgrading services and centralising more urgent care in Carlisle, resulting in lengthy and risky transfers for mothers in labour and seriously ill children and adults.

They would also see some communities lose all their cottage hospital beds, while total numbers at the Cumberland Infirmary and West Cumberland Hospital are also set to drop by 100 long term.

What you stand to lose... the options being considered

1. MATERNITY

• Option 1 - Retaining consultant-led units in both Carlisle and Whitehaven, alongside midwife-led units. Similar to the status quo however some higher risk births – approximately 100 to 200 per year – would still go to Carlisle. Bosses say this option is not sustainable due to recruitment problems and leaves services at risk of short term closures.
• Option 2 - Midwife-led unit only in Whitehaven with consultant-led unit in Carlisle. Although consultants would in Whitehaven during the day (8am to 8pm), they would only provide antenatal and postnatal care. All higher risk births would go to Carlisle, with a dedicated maternity ambulance on standby. Approximately 300 to 400 births a year would take place in Whitehaven, dropping from more than 1,000 now. Possibility of planned, lower risk caesarean sections taking place in Whitehaven in future. Bosses say this would help meet modern care standards and staffing challenges provided transport issues can be resolved. Up to 80 women a year needing emergency gynaecology services would also have to travel to Carlisle.
• Option 3 - No births at all at West Cumberland Hospital, just antenatal and postnatal care. All women would have to travel to Carlisle’s consultant-led unit to give birth. Health chiefs say this is most likely to meet modern care standards, is most deliverable and would be easiest to staff. However transport and contingency plans would need addressed, and the Carlisle unit would have to be expanded to cope with extra births. About 200 women a year needing would also have to go to Carlisle for emergency gynaecology services.

SUCCESS REGIME PREFERRED OPTION: 2

CAMPAIGNERS PREFERRED OPTION: None of the above. Retain full 24/7 consultant-led unit and all services.

2. CHILDREN'S SERVICES

• Option 1 - Short stay paediatric ward at West Cumberland Hospital with some overnight stays for monitoring. All children with more serious conditions transferred to Carlisle. Only lower risk illnesses being cared for in Whitehaven. Bosses say this option would have travel implications for families but ease workforce issues and improve safety. Would need a dedicated ambulance transfer service.
• Option 2 - Short stay paediatric ward at West Cumberland Hospital but no overnight beds. Dedicated in-patient unit would be created in Carlisle to serve whole of north and west Cumbria. All children needing inpatient treatment or overnight observation would have to go to Carlisle. Bosses say this would reduce the risk of short notice closures due to staffing issues. Again transport issues would need to be addressed.
• Option 3 - Outpatient services only in west, no beds at all. Dedicated in-patient unit created in Carlisle to serve whole of north and west Cumbria. Bosses say this would improve safety and outcomes, and significantly ease existing workforce pressures. It would reduce operating costs but also require investment in a new unit. Transport again an issue.

SUCCESS REGIME PREFERRED OPTION: 1

CAMPAIGNERS PREFERRED OPTION: None of the above. Retain full 24/7 children's ward with long stays if appropriate

3. COMMUNITY HOSPITALS

• Option 1 - Beds in Alston, Wigton, Maryport would close, with 104 beds consolidated across the remaining sites. Hospitals in Brampton, Keswick, Cockermouth, Workington and Whitehaven’s Copeland Unit would gain beds, taking their totals to 16, but Penrith would lose four. More care would instead be delivered in people’s homes.
• Option 2 - Beds in Alston, Wigton, Maryport and Workington would close, with 104 beds consolidated across the remaining sites. Penrith would also lose four beds. Again, the other hospitals would gain beds. More care would instead be delivered in people’s homes.
• Option 3 - Beds in Alston, Wigton, Maryport and Cockermouth would close, with 104 beds consolidated across the remaining sites. Penrith would also lose four beds. Again, the other hospitals would gain beds. More care would instead be delivered in people’s homes.

*Option 4 - All community hospital beds would close, except in Penrith and Whitehaven’s Copeland Unit (part of West Cumberland Hospital). A new community hospital unit would be built in Carlisle and 104 beds consolidated across the three. This would mean Brampton and Keswick also losing beds. More care would be delivered in people’s homes.

SUCCESS REGIME PREFERRED OPTION: 1

CAMPAIGNERS PREFERRED OPTION: None of the above. They have put forward an option 5, to retain all beds and push forward with alternative plans drawn up by League of Friends groups.

4. STROKE

• Option 1 - Existing service would be largely retained with stroke patients care in both Whitehaven or Carlisle. Bosses say current arrangements offer reasonable care but not best practice and is also vulnerable due to staffing issues.
• Option 2 - All stroke cases would be dealt with at a new specialist hyper-acute stroke unit in Carlisle. Only rehabilitation would be provided in Whitehaven. All emergencies would be taken direct to Carlisle. Bosses say evidence shows better outcomes if patients are cared for at a specialist centre, despite additional travel time, though a small number could miss a key window for treatment.

SUCCESS REGIME PREFERRED: OPTION 2

CAMPAIGNERS PREFERRED OPTION: None of the above. Retain emergency stroke services in the west

5. EMERGENCY CARE

• Option 1 - 24/7 A&E retained in both Carlisle and Whitehaven. Similar to the current model, but the West Cumberland Hospital's intensive care unit would be smaller, with some of the most seriously ill patients transferred to Carlisle. Bosses say this would have the most minimal impact on care.
• Option 2 - Daytime only A&E service at West Cumberland Hospital, supported by a 24/7 urgent care centre. More transfers to Carlisle and no overnight care for seriously ill. No intensive care unit.
• Option 3 - No A&E unit at the West Cumberland Hospital, just urgent care services. Major increase in transfers to Carlisle. This would result in the loss of both A&E and intensive care from the west. No overnight care for acutely unwell patients.

SUCCESS REGIME PREFERRED: OPTION 1

CAMPAIGNERS PREFERRED OPTION: None of the above. Retain the existing A&E and intensive care unit

6. TRAUMA & ORTHOPEDICS
Formal proposal to make permanent previous changes - to transferring the majority of trauma and emergency orthopedics from Whitehaven to Carlisle. This decision was taken in 2013 on safety grounds, but there has never been a formal public consultation.

The proposal is that previous arrangements are made permanent, but some more minor procedures return to the West Cumberland Hospital. However campaigners are fighting for the return of all trauma services to the West Cumberland Hospital.

Follow the debate throughout today on this website.