The impact of the Better Health programme on the Upper Dales, the possible increase in distances ambulances will need to travel, and condition of the roads in winter, especially the Buttertubs pass, were the main items discussed at the Upper Dales Area Partnership at Reeth on September 21.
Better Health programme
Edmund Lovell, the communications and engagement lead for the Better Health programme, said that this was aimed at providing a sustainable service by the hospitals which were participating in it. These originally were the Darlington Memorial Hospital (DMH), the James Cooke University Hospital at Middlesbrough, the South Tees Hospital and the University Hospital of North Durham.
Under the government’s Sustainability and Transformation Plans for the NHS that at Durham will not now be included. This change meant that the public consultation on the Better Health programme would not take place until next year, Mr Lovell said.
Compared to the meeting at Hawes his presentation this time did include “travel impacts” – something which greatly concerned residents in the Upper Dales.
North Yorkshire County Councillor John Blackie said that when the maternity and paediatric units at the Friarage Hospital were downgraded in 2013 residents had been assured by the Hambleton, Richmondshire and Whitby Clinical Commissioning Group (HRWCCG) that the DMH would provide these consultant-led services as well as a full A&E department. Residents were very concerned that the Better Health programme could lead to these services no longer being available at the DMH.
Cllr Blackie pointed out that this would mean that most patients from the Upper Dales would face a 60-mile journey by ambulance to a hospital. He also asked if this would cause over-crowding at the James Cooke University Hospital in Middlesbrough and even further delays in ambulance response times. Mr Lovell assured the meeting that these issues will be included in the consultation.
Dr Derek Cruikshank, one of the doctors involved for several years in the planning for the Better Health programme, explained that developments in medical care had not only led to much better outcomes for many patients but also to an increase in specialisation by doctors. There could be a 30 per cent better chance of survival if a patient was taken to a hospital with the specialist skills even if it involved a longer journey, he said.
“We have got to keep up with the pace of the changes that are available. But the cost of these services and the expertise that is required means that we can’t have all of them in every hospital.” Specialists, he added, needed to see enough patients to maintain their skills.
Mr Lovell described this as “critical mass” and that hospitals with sufficient patients would attract such specialists. If hospitals had specific specialisations there would be fewer cancellations of planned operations, he added.
Dr Mark Hodgson of the HRWCCG told the meeting that additional resources were now available at the Friarage Hospital to provide for planned care and to give a better service for those who were critically ill.
Both he and Dr Mike Brookes of the Reeth GP Practice reported that there had been an improvement in ambulance response times. Dr Brookes said this was partly because ambulance crews could now seek the advice of local GPs rather than take all patients to hospital.
But those living in the Upper Dales were still very concerned about the amount of time it can now take for ambulances to return from the long journey to Middlesbrough and felt that the Better Health programme could make the situation worse.
Gill Collinson of the HRWCCG supported the objective of the Better Health programme to bring medical services closer to the patients and so reduce the number of delayed discharges from hospital. As part of this there has been a trial of the “Step-up/Step-down” scheme at Sycamore Hall in Bainbridge (*see below).
“This is a brilliant initiative,” said West Burton parish councillor Jane Ritchie.
The Buttertubs pass will not be upgraded to a Priority One road for winter gritting Richard Marr, the new NYCC Richmondshire Area Highways Manager, told the meeting.
He was introduced by North Yorkshire County Councillor Don Mackenzie whose remit as a member of the county council’s executive included highways and transport. “You should blame the councillors who create policies and not the managers who carry them out,” Cllr Mackenzie said. “The problem is the budget cuts – we’ve had a 40 per cent cut. We are the biggest county in England and have 6,000 miles of roads.”
Mr Marr quoted the government legislation which stated that highways authorities had a duty to ensure safe passage along roads in times of snow and ice “as far as reasonably practical.”
The Priority One roads in the Dales were those running from east to west providing access between the main centres of population to the A1.
“Buttertubs doesn’t fit the criteria for a Priority One – you can’t look at it in isolation compared with similar roads across the county. Budgets are limited and we have to do what we can within the limits that we have and we can’t do everything,” Mr Marr said.
Cllr Blackie argued that the Buttertubs road was a very important link between Upper Swaledale and Hawes and when it was closed residents had to drive an additional 30 miles.
Others at the meeting pointed out that there were times when the A684 did not need gritting but the Buttertubs road was impassable due to snow or ice. So would it be possible to grit the Buttertubs road at such times and so keep access open for ambulances as well as residents?
Mr Marr replied: “The procedure is that if the Priority Ones do not need treatment then we can do the Priority Twos. We would not do that if the forecast said the temperature would rise before 10 o’clock. If there are certain days that the part of the Priority Two network which needs treating is just the Buttertubs then I am expecting that will get done.”
He was also asked why the grit store at Hawes was not used regularly instead of the grit wagons having to return to Leyburn to be re-filled.
“Hawes will be used but only when we are running continuously [in very bad weather]. For routine morning treatments we can still operate from Leyburn,” Mr Marr said. He added that it didn’t make sense to have a man and a machine at Hawes to load grit for routine gritting.
Geraldine Coates, the vice-chair of Grinton parish council, told Mr Marr that the road between Grinton and Redmire was, like the Buttertubs road, an important north/south link for residents but this also had Priority Two status for winter gritting. She repeated the request made by the parish council last November for a barrier to be placed along the side of the road at Grinton Bank so that cars could not topple over the edge in icy conditions.
About repairing roads Mr Marr stated: “We are looking for ways to keep road closures as short as possible. We also have to keep in mind the health and safety of our workers. Some drivers whiz past them at 60mph. Three [workers] were hit by vehicles in the last few months, one deliberately.”
It was reported that part of the road through Swaledale which was recently resurfaced is already showing signs of wear.
*Step-up/ Step-down beds at Sycamore Hall, Bainbridge and Kirkwood Hall, Leyburn: This would allow Wensleydale patients to have up to six weeks nursing care locally either on coming out of hospital, or to prevent them from going into hospital. Patients will be looked after by their GP, District Nurses and others depending on their needs