Thursday, May 31, 2007

The Politics Show

Make a date with BBC1 on Sunday 3rd June between 12 noon and 1pm. City Hospital will be featuring during the hour so turn down the oven, put your feet up and see what you make of it. Alternatively don't forget to record it so you can watch it later. I believe that there will be a longer slot than is normally available on TV News.


Tuesday, May 29, 2007

Surgery Plans Referred to Secretary of State

Councillor Alden and the Birmingham Council Health Scrutiny Committee have given their judgement on the Trust’s proposals for Emergency Surgery and Trauma. It is a resounding rejection in no uncertain terms. The case for the people local to City Hospital continuing to have access to the same level of emergency care without having to face additional ambulance journeys while they wait for a new hospital has been upheld, and quite rightly so. Why should those with the greatest health care need have to put up with the worst service?

Now it’s over to the Secretary of State for Health. We must all hope and pray that Mrs. Hewitt convenes the Independent Reconfiguration Panel which she is empowered to do. We can then present our evidence to this Panel which is increasing in quality and quantity by the day. Of course there is always the possibility that the Trust might decide to “review the situation” and choose an option that preserves the emergency services for the people. Wouldn’t that be the most sensible way forward for all concerned? Let’s get on and make 2010 happen as soon as possible. Surely that would be best for everyone!

Ken Taylor, City Hospital Supporters Group, 29/05/2007

Health Overview & Scrutiny Committee
Birmingham City Council
The Council House
Victoria Square
Birmingham B1 1BB
Tel: 0121 464 7457
Fax: 0121 303 4555

Right Honourable Patricia Hewitt MP
Secretary of State
Department of Health
Richmond House
79 Whitehall
London SW1A 2NS


(Please quote in your reply)

Dear Minister

Referral of Sandwell and West Birmingham Hospitals NHS Trust Shaping Hospital Services for the Future Consultation

I write to inform you that the Birmingham City Council Health Overview and Scrutiny Committee is referring the decision by Sandwell and West Birmingham Hospitals NHS Trust’s proposals to consolidate all of the Trusts emergency surgery provision at its Sandwell hospital site. This referral is made under Section 4(7) of The Local Authority (Overview and Scrutiny Committees Health Scrutiny Functions) Regulations 2002.

The Committee feels that the part of the Shaping Hospital Services for the Future Consultation relating to the provision of Emergency Surgery will result in a reduction of service for the people of Birmingham and is not premised on clinical need. In evidence provided to Birmingham and Sandwell Joint Health Overview and Scrutiny Committee the Trust stated that currently the greatest need for emergency surgery is located on the City Hospital site. The Committee does not believe that the decision to consolidate emergency surgery on the Sandwell Hospital site has been taken with patient safety as the prime concern.

The consultation process carried out by the Trust clearly demonstrates that the proposals for surgery set out in the consultation document were opposed by the majority of respondents. The Committee does not believe that the twenty four hour surgical assessment unit announced by the Trust as a result of the consultation is a sufficient variance of the original proposal and will still result in a substantial diminution of service for one of the most deprived areas of Birmingham.

In addition the Committee believes that Sandwell and West Birmingham Hospital NHS Trust have not demonstrated a clear case as to why emergency surgery could not instead be consolidated on the City Hospital site. We feel this option should now be considered as a matter of urgency in order to safeguard the welfare of Birmingham patients. The Committee also believes that any decision taken by the Trust should be based on demographic and geographic indicators.

The Committee is extremely concerned that the decision to proceed with the proposals is not in the interest of patients in Birmingham and is contrary to the views expressed in the consultation process. The Birmingham City Council Health Overview and Scrutiny Committee requests that the decision is referred to the Independent Reconfiguration Panel as soon as possible.

I look forward to your response in this matter.

Yours sincerely

Councillor Deirdre Alden
Chairman of Health Overview and Scrutiny Committee

CC Cynthia Bower - Chief Executive – NHS West Midlands
CC John Adler - Chief Executive - Sandwell & West Birmingham Hospitals TrustCC Tony Shaw – Chief Executive – Independent Reconfiguration Panel

NB: A printable version of this document is available at the following address:

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Wednesday, May 23, 2007

An Open Letter to the SHA

The following letter regarding moving Paediatric and Emergency Surgery and Trauma beds from City to Sandwell Hospital as part of the interim reconfiguration plans was sent to the Strategic Health Authority, the Birmingham Mail and to all staff at City Hospital. A copy was also sent to the Commission for Racial Equality today. The document referred to in the letter can be found here. The Birmingham Mail's coverage of the letter is available here.

Ms. Elisabeth Buggins,
Chairman West Midlands Strategic Health Authority,
St. Chad’s Court,
213, Hagley Road,
Birmingham B16 9RG. 20th May 2007.

Dear Ms. Buggins,

Re: Sandwell and West Birmingham Hospitals NHS Trust’s Interim Reconfiguration Proposals - Shaping Hospital Services for the Future.

I am writing to you on behalf of the City Hospital Supporters Group and this is an open letter that is being simultaneously passed to the Birmingham Mail. You may know that we are a group composed of members of the community served by City Hospital and also members of staff from across all the staff groups of the hospital. The one commitment we all share is to ensure that local people can rely on continuing to receive a high quality hospital service. We support the 2010 proposals for the new hospital combining both City Hospital and Sandwell Hospital on the Grove Lane site. We are only too well aware that this exciting new development is still only at the very early planning stage, and many things could happen in the next few years that could jeopardise or delay its opening. At the moment it is not projected to open before 2013/14.

City Hospital Supporters feel very strongly that patients at both City and Sandwell Hospitals should continue to receive the same quality of service while they await the new build. The Trust’s Interim Reconfiguration Proposals do not threaten the services provided for the population of Sandwell Hospital, but unfortunately they do threaten those services for the population served by City Hospital. The Trust’s initial proposals that went out to consultation would have moved Emergency Surgery and Trauma beds to Sandwell and Paediatric beds providing only a 12 hour Paediatric Assessment Unit at City Hospital. As a result of our campaign on behalf of local people the consultation period was increased by a month, the 12 hour Paediatric Assessment Unit became a 24 hour unit and finally they decided to provide a 24 hour Surgical Assessment Unit. However these proposals are still fundamentally flawed.
I believe you will find that the Trust’s Reconfiguration Proposals conflict with their own Race Equality Scheme May 2005-April 2008 which is easily accessible on their website. The following data have come from this source. It states that 20% of Sandwell residents and 30% of Birmingham residents are from Black and Minority Ethnic groups. Ladywood, Handsworth, Soho and Aston have significantly higher proportions of Minority Ethnic residents: 49%, 81.5%, 76.2% and 70.6% respectively. They go on to look at the percentage of Black and Minority Ethnic inpatients by hospital in 2004-2005. The figures for Sandwell Hospital are Black and Ethnic Minorities 13.4%, White 70.5% , Unknown 16.1%. For City Hospital the figures are very different: Black and Ethnic Minorities 45.9%, White 45.4% and Unknown 8.7%. They admit that Sandwell’s data is not as good but even if we were to assume that all the unknowns at Sandwell were Black and from the Ethnic Minorities there total figure would only be 29.5% compared to 45.9% for City. If we exclude the Unknowns it is Black and Ethnic Minorities at City Hospital 45.9% against 13.4% at Sandwell Hospital! A more than threefold difference!

In paragraph 4.1 the policy states and I quote “Equality for Sandwell and West Birmingham Hospitals NHS Trust means that all members of our community and workforce must have equal access to the services and opportunities offered by the Trust regardless of gender, race, ethnic background, disability, religion, sexual orientation or age.” In the paragraph under Meeting the Specific Duties it states in 6.1 “To assess its existing policies and service delivery for any adverse impact on the promotion of race equality. Crucially under paragraph 6.2.3 it says and I quote “if impact assessments show that a current policy, service or function results in greater adverse impact, or if opportunities arise which allow for greater equality of opportunity to be promoted, the Trust will ensure that the policy, service or function is revised and targets are set to reduce or eliminate disadvantage.”

Now I can hear you asking where is this all leading? Well it is very simple. If the Trust were to implement its plans for moving inpatient Paediatric and Emergency Surgery and Trauma beds from City Hospital to Sandwell Hospital and establishing 24 Hour Assessment Units in Paediatrics and Surgery at City, we would argue that they would be treating the City Hospital patients that have a different ethnic balance to Sandwell in a different way. In particular they would be exposing two thirds of the Emergency Surgical patients and two thirds of the children brought to City Hospital A&E and needing admission, to transfer by ambulance to Sandwell Hospital or if no bed were available there, to another hospital. The ambulance journey would not be to better care i.e. an ITU or HDU bed, but simply for managerial and financial convenience. It would be an ambulance journey not for the benefit of the patient but for the benefit of the Trust and would undoubtedly put City Hospital patients with their higher Black and Minority Ethnic mix at greater risk than the patients with a different ethnic mix admitted to Sandwell Hospital. We believe that this conflicts with the Trust’s Racial Equality Policy and we presume the Commission for Racial Equality would be of the same view. The Trust did consider five options before selecting one that impacted on Emergency Services producing a differential effect on the two hospital populations. City Hospital Supporters believe that now is the time for the Trust to choose an option that does not impact upon Emergency Services at all, and does not involve moving significant numbers of ill patients, children or adults unnecessarily.

Needless to say this will form part of the evidence we will be giving to the Independent Reconfiguration Panel. Under the circumstances we feel that there should be no move of Inpatient Paediatrics from City Hospital to Sandwell Hospital while the situation is being satisfactorily resolved. I would appreciate an early reply on this most worrying situation.
With kind regards,

Yours sincerely,


City Hospital Supporters Group.

cc. Cynthia Bower
Sue Davis
John Adler

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Sunday, May 20, 2007

The Achievements of City Hospital Supporters

Since it came into being during the second half of 2006 we have made a number of achievements of which we can be proud:

1. The consultation period was increased by one month.

2. The proposed 12 Hour Children's Assessment Unit at City Hospital was increased to a 24 Hour Unit.

3. A 24 Hour Surgical Assessment Unit was introduced towards the end of the consultation.

4. We have achieved a referral to the Secretary of State for Health by the Birmingham Council Health Overview and Scrutiny Committee of the Emergency Surgery proposals (to move the inpatient beds from City to Sandwell)

This represents good progress but we need to achieve more. City Hospital Supporters cannot rest until we have ensured equality of service provision to patients across the Trust especially when it comes to Emergency Services.

You can show your solidarity with us now! Visit the website every day as the story is very fast moving. Pass details of the website to friends and colleagues. Get contact details of those who want to join our great enterprise and let me have them.


Friday, May 18, 2007

Good News and Bad News.

The combined Health Overview and Scrutiny Committees for Birmingham and Sandwell Councils met at the Sandwell Council House at 10am today with representatives of the Sandwell and West Birmingham Hospitals NHS Trust.

The Trust had arranged for their appointed medical experts all Sandwell based doctors to be there with one very notable exception, Mr. Peter Ahee the Director of A&E at City Hospital. Dr. Ken Taylor was present representing City Hospital Supporters and he was permitted to contribute to the meeting.

The QUAD team again presented their data on the consultation. There was some discussion on the Towards 2010 proposals but there was general support for the new hospital but concern about how the proposals for the community component would function with the hospital.
The reconfiguration proposals were then discussed after the QUAD team had again presented the consultation results demonstrating very significant opposition to the Trust's proposals on Emergency Surgery and Paediatrics at City Hospital. Great concern was expressed that the data indicated that there had been inadequate participation by the ethnic minorities in the consultation process. It was appreciated that had more of this population expressed their views it would have made opposition to the proposals even more overwhelming.

The debate that followed on reconfiguration was extremely lively with the Chair of the Birmingham Committee Deirdre Alden expressing the very great concerns her councillors had about both Emergency Surgery and Paediatrics. Peter Ahee the Director of A&E at City once again made clear to Councillors that two thirds of the children, and two thirds of adults with surgical illnesses brought to City Hospital A&E would have to move by ambulance to Sandwell or elsewhere because they needed to stay in hospital longer than 24 hours. This is a key point as these patients would be subject to unnecessary ambulance journeys that would put them at increased risk.

I spoke briefly at the end of the meeting making clear City Hospital Supporters were fully supportive of the new hospital on the Grove Lane site. Our concern was to ensure no deterioration to emergency service provision at either hospital while we awaited the new hospital which was no more than a preliminary plan at present. I made clear that unnecessarily moving patients in ambulances and exposing them to increased risks was not acceptable especially as the Trust had rejected options that would preserve fully supported emergency services on both sites. I pointed out that however flawed, the consultation had roundly rejected the Trust's plans. I also mentioned that our petition had supported 24 hour Assessment Units in Paediatrics and Surgery and opposed moving beds in these specialties from City to Sandwell.
This meeting ended shortly afterwards at about 12.10pm.

The Birmingham Councillors then met until about 1.10pm and I was fortunate to be present when Councillor Alden announced the results of their deliberations. Emergency Surgery was to be referred to the Secretary of State for Health. The Scrutiny Committee were very concerned about the proposals for Paediatrics and she would be writing to West Midlands Strategic Health Authority to express her concerns. I believe there was mention of some monitoring and also some conditions. I will be seeking early clarification on these issues.

We now have a further great opportunity to influence the debate in the interests of patients. We will make sure that we present evidence to the Independent Reconfiguration Panel that will presumably be convened by the Secretary of State. The decision on Paediatrics is a setback but there are several avenues to be explored in this area, and this you can rest assured, we will be doing. Watch this space!

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Thursday, May 17, 2007

Tomorrow a Day of Decision for the Health Scrutiny Committees of Birmingham and Sandwell

City Hospital Supporters are not against modernisation and change but it must not increase risks to patients living in Birmingham or Sandwell. The Sandwell and West Birmingham Hospitals NHS Trust made public a letter from the Chief Executive of the West Midlands Strategic Health Authority to the Chief Executive of the Trust dated 3rd May 2007 at its Trust Board Meeting last week. In that letter the Strategic Health Authority list nine tests that must be satisfied in their minds in order to gain their support for the Trust proceeding with its reconfiguration proposals. They are of the view that these tests have been satisfactorily met. We would argue about tests 3,5,6.

Test 3 asks "Do they deliver real patient benefits in terms of quality and safety?"
We would simply ask is it safer to move sick children and adults after they have been "stabilised" at City Hospital or safer to care for them completely on one site? We believe the answer is self-evident.

Test 5 asks "Are the risks of implementing changes clearly identified and clearly mitigated?"
The Trust has not made this information public. Where is the data on ambulance travel times between City and Sandwell hospitals at different times of day? Have they done a full risk assessment? What are the risks for patients? What other hospitals in the country have such an arrangement and what has been their experience? The Strategic Health Authority needs answers to these questions as do we all.

Test 6 asks"Do they have clear support from the clinical workforce and do they respond to the future challenges of maintaining high quality clinical rotas etc under increasingly restrictive regulations?"

City Hospital Supporters KNOW that the Trust does not have the support of the Paediatricians and General Surgeons directly involved in losing inpatient services from City Hospital. We doubt that the rest of the medical staff at City Hospital truly support the Trust's reconfiguration plans. There has not been a ballot of City Hospital medical staff. The Trust has listened mainly to its appointed medical leaders not based at City Hospital. They have not listened to those directly involved.

So our hope for tomorrow is that the plans to move inpatient Emergency Surgery and inpatient Paediatrics will be referred to the Secretary of State so that the Independent Reconfiguration Panel can review the plans and listen to our concerns presented as evidence.

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Wednesday, May 16, 2007

The Five Options For Reconfiguration Considered by the Trust

  • Status Quo:
  • Option 1: Centralise inpatient elective general surgical specialties only:
  • Option 2: Main inpatient emergency service at Sandwell Hospital and main inpatient elective service at City Hospital (consultation proposals):
  • Option 3: Main inpatient emergency service at Sandwell Hospital and main inpatient elective service plus a 24 hour SAU at City Hospital:
  • Option 4: Centralise inpatient elective general surgery and orthopaedics but retain inpatient emergencies at both sites.

City Hospital Supporters point out that the Status Quo and Option 4 both leave fully supported A&E Services at both hospitals and would be acceptable. Option 4 would allow reconfiguration and also guarantee both A&E Departments. We believe that fully supported A&E Departments for both hospitals at least ensure a good emergency service for local people which should be an absolute core requirement of the NHS and this view was expressed in the Yvette Cooper letter reproduced below.

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Sunday, May 13, 2007

A Very Important Letter

The following is a copy of the letter from Yvette Cooper, Parliamentary Under-Secretary of State for Health at the time of the merger between Sandwell Healthcare Trust and City Hospital NHS Trust, to Richard Steer who was Chairman of City Hospital NHS Trust at the time. It sets out conditions of the merger and I think it is quite clear in respect to the current interim reconfiguration plans for Sandwell & West Birmingham Hospitals NHS Trust - in particular

"A key feature of the merger proposals... is that the two hospitals... will continue to provide the full range of clinical services to support local Accident and Emergency Services."

Please click on the image to enlarge it.

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Trust Board Meeting Review (10th May 2007)

The following is an account of the public Trust Board Meeting on Thursday at which the Trust decided to ratify the interim reconfiguration plans for Sandwell & West Birmingham Hospitals NHS Trust, which plans to replace the current emergency inpatient paediatric and general and trauma surgery beds at City Hospital, Birmingham with a 24-hour Paediatric Assessment Unit, and a 24-hour Surgical Assessment Unit.

The Trust Board met at 2.30pm on Thursday 10th May with the public present in order to ratify proposals arising from both Towards 2010 and the Reconfiguration of Services. At the start of the meeting the Chair announced that the public could speak at the start of proceedings, but after that they would have no opportunity to ask questions, comment or seek clarification. Effectively they were being asked to comment on material that had not been presented to the meeting. Several members of City Hospital Supporters were present and took the opportunity to complain about this most unorthodox and undemocratic method of conducting business, and made their views on the proposals before the Board known. It seemed from what was said at the meeting that there had been a previous private meeting of the Board.

QUAD the organisation based at Warwick University were asked to present their findings on the two consultations. We then had a pseudo-scientific presentation of methodology and results. There was no mention of how they checked the questions for their suitability and validity. There was no mention of the reading age required and if it matched the reading age of the population under study. It was accepted that the ethnic mix of the respondents to the questions in the two booklets did not match the ethnic mix of the population served by City Hospital, consequently ethnic minorities were significantly under-represented. However although the process was flawed one message emerged very clearly that the population resoundingly rejected losing inpatient Paediatrics and inpatient Emergency Surgery from City Hospital. A more carefully performed study accurately representing the ethnic mix of the actual patient population is likely to have made these results even more spectacular.
The Board went on to receive a paper on Paediatrics creating a sub-regional Neonatal Unit at City for complex cases, and a more basic unit at Sandwell. Inpatient Paediatrics were to move to Sandwell with a 24 Hour Paediatric Assessment Unit at City. Two Sandwell Consultant Paediatricians told the Board that this was the way to go. There are three General Paediatricians at City Hospital plus Neonatologists but not one of them attended the meeting. Were they invited to attend and give their views? The Board accepted what they were told virtually without question and the paper was passed unanimously.

They then considered Emergency Surgery. Another paper was produced setting out the plans to move inpatient Emergency Surgery from City to Sandwell and establish a 24 Hour Surgical Assessment Unit at City. This paper was introduced by Dr. Hugh Bradby the Medical Director and Sandwell-based Gastroenterologist. He went on to ask Mr. Peter Ahee Director of A&E at City to outline the differences patients would observe if the Trust’s paper were implemented. Mr. Ahee told it as it is. If you were a sick child admitted to the Paediatric Assessment Unit or an adult admitted to the Surgical Assessment Unit, if it became clear that you needed to stay in hospital longer than 24 hours you would be moved to Sandwell. This would amount to two thirds of the children and two thirds of the adults admitted to these units. No questions were asked by the Board on what would happen if Sandwell beds were full although the hope was expressed that Birmingham Children’s Hospital might help out and I believe someone is going to have a word with them. Mr. Ahee also pointed out that the Specialist Surgical Registrar would be allowed to reside at home overnight provided he could return in 20 minutes. The Chief Executive thought that the Surgical Registrar should be required to remain resident in the hospital while the situation is risk assessed possibly up until 2009.
The Director of Surgery at City who is a Trauma and Orthopaedic consultant was called and he recommended the proposals to the Board, although he clearly stated that he was only speaking on behalf of Trauma and Orthopaedics. Then a Sandwell General Surgeon was asked to speak and he told the Board why they should vote for the proposals with great enthusiasm. An Anaesthetist, I believe from City Hospital also seemed content with the arrangements. No General Surgeon emergency or otherwise based at City Hospital was called by the Trust to speak about the subject in which they have the expertise, and which directly concerned them. The Board passed the second paper unanimously.

It is for the public to decide on the evidence presented, which I believe I have recollected correctly, if the fateful decisions taken by the Trust Board are sound. Was it a reliably designed consultation that was robust and accurately reflected the views of all the population affected? Do the decisions take due account of the very clear views expressed by the consultation data available flawed as it is? Why did we not hear from at least one Paediatrician and one General Surgeon based at City giving their honest professional views? Add to this the fact that two thirds of children and two thirds of surgical patients admitted to the respective 24 hour Assessment Units will be moved to Sandwell or elsewhere within 24 hours these decisions have got to be unacceptable. The emergency care provided for the people of Birmingham will not be as good as at present as a result of these decisions. There were four other options that were rejected in favour of the current option, and we believe that two of those options would have met the aspirations of the local community and the results of the consultation.

City Hospital Supporters would welcome a reconfiguration that would improve services to patients, and we believe this can be achieved. The Trust’s current reconfiguration will involve a diminution of existing emergency services at City Hospital.

Consequently City Hospital Supporters are calling on the Birmingham Health Overview and Scrutiny Committee at their meeting next Friday 18th May to reject the Board’s plans and refer them to the Secretary of State for Health who in turn would arrange for them to be reviewed by the Independent Reconfiguration Panel. This arrangement formed part of the conditions for approving the merger of City and Sandwell Hospitals set out in the letter shown above sent to the Chairman of City Hospital NHS Trust Richard Steer by the the Parliamentary Under-Secretary for Health at that time Yvette Cooper.
City Hospital Supporters would wish to present evidence to this Panel.

Ken Taylor on behalf of City Hospital Supporters 15/05/07

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Monday, May 07, 2007

Trust Make Decision on Interim Plans

On an e-mail sent to staff on Friday, the Chief Executive announced that as a result of the consultation exercises held earlier this year there will be a 24-hour Surgical Assessment Unit (SAU) and a 24-hour Paediatric Assessment Unit (PAU) at city to support the A&E department on this site. This means that the petition we submitted to Birmingham City Council's Health Scrutiny Committee has been successful. However, it also means that emergency inpatient paediatric and general and trauma surgery beds will be removed from the city site. In other words, after 24 hours after being admitted in an emergency, children will have to be transferred to either Sandwell General or Birmingham Children's Hospital, and general and trauma surgery patients will be moved to Sandwell Hospital.

If you have issues with this I suggest you turn up to the public Trust Board Meeting at the Wolfson Lecture Theatre in the Postgraduate Centre at City on Thursday 10th May 2007 at 2.30pm and make your feelings known.

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Thursday, May 03, 2007

CHSG Expands Campaign

At the meeting of the City Hospital Supporters Group on the 24th April 2007, it was unanimously agreed that the scope of the group should be extended to include the effects of the reconfiguration plans on Sandwell Hospital and the community it serves. There are many concerns among the Sandwell staff and community about the provision of acute healthcare in the borough when the two current acute sites are merged onto a single site, which will be close to the present City location.

The main role of the City Hospital Supporters Group until now has been to increase awareness and participation in the consultation process, and to present a petition opposing the interim reconfiguration plans to Birmingham City Council's Health Scrutiny Committee. This month the Trust will announce the results of the consultations and its plans for the interim reconfiguration plans and the Towards 2010 project. It will be doing this on Thursday 10th May 2007 at 2.30pm in the Wolfson Lecture Theatre in the Post Graduate Centre at City Hospital. We would urge everyone who can make it to be present at this meeting, because it is important that the Trust is reminded of the strength of opposition to these proposals should they decide to proceed with them. A large turnout from those of us opposed to the Trust's reconfiguration plans will be a timely reminder to the Trust board that they exist to serve us, the staff and community, and not the other way round. In the recent past, it is clear that the Trust board has expected the local community to change to accommodate their plans. This was unacceptable, and although some movement has been made towards more acceptable outcomes, we still need to remind them of our concerns to ensure that we maintain the best possible acute healthcare services for the local community in the short to medium term.

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