Attachment 2. Reasons for choice of preferred option in surgery.

This attachment also accompanied the letter from the Chief Executive.

1. The plan allows the concentration of elective general surgical specialties inpatient activity at one main site presenting the benefits of improved critical mass for future service development.

This advantage needs to be set against the very major disadvantage of not having properly supported emergency services on both sites, and in particular at the larger of the two hospitals namely City.

2. The plan allows the consolidation of elective inpatient orthopaedics alongside the elective general surgery to provide a major elective surgical site.

It seems elective work is taking precedence over emergency work. Surely this has to be seriously questioned with a hospital the size of City situated right in the centre of Birmingham and with the workload of its A&E Department? 103,000 referrals a year.

3. The plan separates emergency and elective workstreams enabling improved management of patients in a larger more focused emergency inpatient site.

At present City Hospital is able to deal with nearly all its emergencies in house giving a first rate service. Why are we undermining the service at City for something only to be achieved if and when this new hospital materialises?

4. The plan retains maximum possible local access for elective work with outpatients, day cases and 23 hour stay surgery retained at both sites.

The status quo or would retain a First Class Emergency Service on both sites. When the chips are down the people need a decent Emergency Service.

5. The plan retains maximum possible cover for the elective site including:
- on-call consultant surgeon and orthopaedic surgeon
- on-call surgical registrar
- junior doctor presence on site through HaN team
- out-of-hours access to emergency theatre
- full anaesthetic cover

But means about 12 patients a day who are acutely surgically ill or traumatised will have to make an unnecessary journey to Sandwell Hospital in order to find a bed. Their relatives will have to travel further to see them.

6. The plan retains maximum possible local access for emergency surgery through a 24 hour Surgical Assessment Unit at the elective site to provide good local assessment services.

People not only need good access for emergency surgery they need to remain in the hospital they have been admitted to unless there are over-riding medical reasons for a move.