THE Bucks Free Press has repeatedly asked the Bucks NHS to release more detailed evidence surrounding the changes at Wycombe Hospital.

More than 30 reports and studies are referenced in the proposals, but few of them comment directly on hospital services in Buckinghamshire.

However, it is clear there is a wealth of clinical evidence to support centralization in general.

A letter to the Guardian newspaper, signed by The Academy of Medical Royal Colleges in 2010, sums up the arguments.

It says: "Survival and recovery rates would improve markedly with many lives saved. As techniques and technology have developed over recent years, speciality rather than proximity has become the key for patient safety....

"Patients may indeed have to travel further for some specialist care, but if it is significantly better care then we believe that centralisation is justified."

Meanwhile, one report by The Institute for Public Policy Research makes recommendations about how health authroities present the arguments for change.

It says: "The NHS does not have a culture of sufficient openness to make a sceptical public trust the [consultation] process. If people are being asked to support controversial proposals, they need to have practical evidence to back up the theory....

"Where a local trust has concerns about safety, royal colleges can provide ‘invited reviews’ of services. These provide an independent clinical view on the viability of existing services.

"If trusts made greater use of invited reviews at an early stage of the engagement process, and made the findings of the review public, they would be able to make the clinical case with the backing of an independent external body."

We asked Bucks health chiefs if there had been any ‘invited reviews’ of the emergency medical services at Wycombe Hospital.

The Buckinghamshire & Oxfordshire NHS Cluster said it was already clear that the emergency departments at Stoke Mandeville and Wycombe do not meet the levels of staffing recommended by the College of Emergency Medicine.

It added the plans involve several Royal Colleges and an 'overview' was provided by the National Clinical Advisory Team [NCAT], which works with Royal College guidelines.

However, NCAT's purpose was to "review the reconfiguration plans", and its report does not go into any detail about the viability of existing services.

We also asked the following questions:

Q: Can you send us a copy of the clinical risk assessment for the Better Healthcare in Bucks proposals?

A: This is being reviewed and updated and will be available after the Better Healthcare Programme Board has agreed it on March 21.

Q: Do you have any clinical evidence of improved outcomes since Wycombe's main maternity and A&E wards were moved to Stoke Mandeville?

A: Maternity was centralised in order to ensure a robust and sustainable consultant team (not split across two sites). There is substantial evidence from elsewhere of the benefits of centralising trauma services, and the importance of proximity to emergency surgery. Buckinghamshire Healthcare NHS Trust are currently looking at figures on both maternity and trauma to see what might be helpful.

Q: A report from The Institute for Public Policy Research, referenced by your proposals, says: "The concerns of local patients and residents about access to acute services in an emergency should also be addressed [during a consultation]...This should include some estimates of the optimal time window for treatment of particular conditions..." Can you provide data to show the trade-off between specialist care and extended travel times?

A: With cardiac and stroke patients there is a time frame within which particular treatments need to be given. With emergency medical conditions, there are other important factors: the proximity of emergency surgery, as recommended by the Royal College of Surgeons in 2006, and access to specialist opinion and the amount of time which specialist consultants and senior doctors can spend with their patients. The recent Dr Foster report showed the higher mortality rates when emergency patients are admitted at weekends when senior specialists are less likely to be available. The changes would allow specialist consultants to spend more time with their specific patients.

Q: Can you provide some more detail about what the plans will mean for senior staffing levels. Do Wycombe and Stoke each currently have 24/7 emergency medicine consultant cover? Do they both have a trained doctor in the department 24/7? How will the proposals change this and can we see an example 'before and after' staff rota.

A: Buckinghamshire Healthcare NHS Trust is working on these.

Q: A report by the Academy of Medical Royal Colleges, referenced in the proposals, says: "A major neglected issue in these considerations is the quality of transfer and transport, in the event of an emergency to a suitable unit...This particular issue requires more serious consideration when discussing issues of reconfiguring services." Will there be increased training for South Central paramedics and Emergency Care Assistants?

A: We are working with South Central Ambulance Service to develop protocols based on the proposals so that paramedics are aware of who should be taken where.

For more details on the plans see related links.