Attachment 1: Reasons for service reconfiguration in advance of new hospital - surgery.

This has been sent out to everybody on the 6th July from the Chief Executive.

1. Changes to the Medical Workforce. Both MMC and the next stage of EWTD implementation have a significant impact on junior doctor numbers in key specialties including surgery. This makes it increasingly difficult to cover two sites in the way we do now. The effect of MMC is already becoming apparent.

The Paediatricians and the Surgeons assure City Hospital Supporters that these are not valid reasons for losing their beds to Sandwell. They are able to put forward plans that would provide cover on both sites and not be more expensive than the Trust's proposals.

2. Critical Mass for Future Development. Many of our services (especially surgical services are too small at each site to have a sufficient critical mass for future development.

It is very unlikely that this applies to City Hospital. However the reason for the new hospital is to bring services together on one site. The sooner the new hospital is built the sooner this can happen. However this is not going to happen imminently and emergency services should not be compromised while the community waits for its long overdue new hospital.

3. Recruitment and Retention. Continuing to recruit and retain the best clinical staff in a competitive labour market requires services that are large enough to attract high quality individuals.

Medically there has continued to be no significant problems recruitng doctors. The Trust were not too bothered about retention when they lost a large number of nursing posts recently in order to help solve the financial problem.

4. Productivity improvements. The next stage of productivity improvements required to ensure best use of resources will be supported by larger inpatient services.

Now this is a new one. Sounds like the supermarket approach. Is it a justifiable reason for making patients suffer an extra ambulance journey and for relatives to travel further? City Hospital Supporters do not think so. This is a gain to be made when the new hospital opens.

5. Preparation for the new hospital. The new hospital will require single clinical teams working in new ways; bringing services together now prepares for this.

Very unconvincing. Time enough to start on that when the new hospital is actually being built assuming it happens. There is absolutely no guarantee that it will.