The recent Berwick upon Tweed Options Appraisal (Arch, June 2018) by Northumberland County

Council (NCC), the NHS Northumberland Clinical Commissioning Group (CCG) and Northumbria
Healthcare NHS Foundation Trust (NHFT) is flawed as:

• it does not take into account all the costs involved

• It is badly researched

• it fails to look at the bigger picture of the needs of the Berwick1 community

Further, the people of Berwick are strongly of the opinion that they are being “robbed” of what
they have and had been promised.

Background
While there had been medical provision in Berwick since 1813 in the form of the Quay Walls
Dispensary. It became inadequate and eventually the present Berwick Infirmary was opened in
1874. It is interesting to note one of the prime reasons was to save “injured patients requiring
operation […] to go by train to Edinburgh”. Transport has improved since 1874; so has medical
care. What has not changed is the inconvenience to patients and relatives caused by the need to
travel great distances, often for very short consultations. Nobody expects Berwick Infirmary to
provide major healthcare but we must retain if not improve the services we have. It is arguable
that, because of the geographic location of the town, extra services should be provided perhaps
disproportionate to the size of the population served.

This is perhaps best summed up by the NHFT Outline Business Case for Berwick Infirmary
Redevelopment (2014). This document laid out the need for building a new hospital on the site of
the present infirmary. At the outset it states, “Berwick is the most isolated community hospital
within Northumbria Healthcare NHS Foundation Trust, and the population has the furthest to
travel for acute general hospital healthcare services.” It then summarises the reasons for
redevelopment of the site:

• Strengthening and building upon an integrated partnership with primary and intermediate care,
secondary care and social services to enable high quality services to be provided locally
• Maximising the availability of services closer to patients’ homes
• Strengthening the service reputation in the context of choice
• Delivering locally based assessment services for patients who may require admission, relieving
pressure on general hospital sites and, where possible, reducing waiting times overall
• Ensuring the right care is provided in the right place and the right setting.
These plans were shelved to allow for further “consultation”.

In 2016 the building of a new leisure centre was promised by the previous administration of NCC.
It would appear to the layman that presumably primarily for cost-cutting reasons the two projects
have been combined into one.

It is recognised that the public sector is facing severe financial constraints, yet the new proposals
outlined in the Berwick upon Tweed Options Appraisal by Arch (June 2018) document downgrade
not only the hospital service, but the provision of sports and leisure facilities to the detriment of
the health and well-being of Berwickers.

The 2018 Appraisal

I would argue this document is badly researched and is biased towards a preferred option; one
that was being strongly promoted to the public in what passed for public consultation. Berwick
has seen this tactic before, most notably in the development of the GWA Walkergate building, ie,
“We have decided what we are going to do and want you to agree with us.” By contrast, in a
recent poll conducted by the Facebook page “A Better Hospital For Berwick”2 demonstrates an
overwhelming objection to the leisure centre/hospital option.

Let us assume that the only feasible sites for the hospital (other than combined with the leisure
centre) are the existing site or that of Seton Hall. The RAG report in the Appraisal highlights the

1 The term Berwick shall be taken to include Tweedmouth, Spittal and the neighbouring rural district.
2 https://www.facebook.com/groups/709693792712030/?
multi_permalinks=716764835338259%2C716759105338832%2C716721392009270&notif_id=1535968181904344&notif_t=group_acti
vity
perceived problems with the two sites preferred by the public. The arguments against the
objections are outlined below.

Present site
Access and parking
There are estimated to be approximately 50 car parking spaces at the Infirmary, located at
Brucegate, the maternity unit and Violet Terrace. These are adequately accessible by the public.
The present buildings are a complex sprawl that have developed over the years. A new building
would obviously rationalise this and could provide better access for parking. Given the lack of
services provided it is questionable that 100 spaces as proposed would be needed.

Ambulance access is arguably less easy yet any cases that are so severe that “every second
counts” will not be brought to Berwick and so the perceived problem does not exist.

Buildings/phasing/governance
The 2014 document states, “An initial, very early feasibility has been completed which has
demonstrated that some form of multi-phase construction can be accommodated within the site.”
What was possible in 2014 is still possible given the will.

Archaeology/Listed buildings
The hospital is not listed. The Maclagan statue on the bank overlooking the Castlegate car park is
Grade II.

The land was open “garden” owned by Stephen Cook until the building of the hospital; no major
archaeology would be expected to be found3. Archaeological investigations were carried out c.
2017 so some idea of the findings must be available. The only area where anything of interest
might be found is on that land adjoining Low Greens as prior to the building of the Elizabethan
Walls (1557–1570), this was the road to Edinburgh and is seen to have buildings on either side on
a map of the 1560s.

Other
1. The advantage of using this site is that there remains the possibility of future expansion.

2. The site is convenient for many people and is by far the public’s choice of site. Bus services
operate to Castlegate.

3 As a historian who has studied medieval Berwick, I believe I speak with some knowledge.
Seton Hall site
Access and parking
It is conceded that access may be problematic, yet possible.

Ground conditions/Buildings/Phasing/Governance
There is surely no problem involved. Any existing building can simply be demolished (planning
permission for demolition was granted in 2016) and replaced by the new build. The document
states a further constraint that “Utility connections are likely to be expensive.” Why this should be
the case is unknown as services existed for the Seton Hall care home and so will still exist.

The site is in private ownership but the cost of buying back has been factored into the costings.

Archaeology
This was open land prior to Seton Hall being built and so no significant finds would be expected.

In contrast, the advantages of using the Seton Hall site have largely been ignored.

• It is closer to the larger population of Tweedmouth.

• Despite the concerns, there is much better access from the A1 bypass should the need arise.

• According to ex-Cllr Eric Goodyer, Berwickshire Housing Association are finding it hard to sell.
Exchanging this site with the present infirmary site would offset costs of acquiring Seton Hall.
The Infirmary site could then be used for much needed sheltered/affordable housing in the
heart of Berwick rather than being out on a limb as Seton Hall is.

Leisure centre site

At first glance, the Appraisal RAG report shows the leisure centre site to present fewer problems
than the other two. It fails to point out certain points and concerns voiced by the public.

Facilities The main objection to this proposal is the reduction in services for both the hospital and
leisure centre. While the Appraisal draws attention to the loss of the outdoor pitches, nowhere
does it state where or when these would be replaced. It is ironic that a proposal supposedly
improving the health of the community is removing the very facilities used at present to facilitate
this. Until this question is answered, this proposal should not be considered the best solution.

In addition to the loss of these outdoor facilities, it is understood the popular indoor bowling
green, the squash courts and other internal facilities will not be included in the new build.

The loss of services to the hospital are assessed later in this document.

Access While located off the A1167, this is a very busy junction. The addition of the hospital will
exacerbate this.

Hygiene Will internal heating/ventilation systems be shared? Leisure centres tend not to be as
hygienic.

Privacy There is great concern that there should be separate entrances and reception areas for
both facilities.

There is a trend for outdated leisure centres to be replaced by “wellness hubs” which often
include not just traditional sports centre facilities but libraries and social services as well as GP
surgeries. This has been much promoted by inactive in a document “Blueprint for an Active
Britain: Milestone Review”. The organisation describes Orford Jubilee Park, opened in 2012 as a
“flagship community, leisure, health and education centre in Warrington”4 . A cursory study of the
reviews of its medical facilities is far from favourable.5

Indeed, the supposed benefit of shared facilities is deeply flawed. No one would dispute the idea
that a healthy lifestyle is better for the individual, society at large and the the NHS budget but no
evidence can be found to support the notion that, for example, someone advised to lose weight is
more likely to take up membership of a gym just because it is next door. Councillor Peter Jackson
states in a press release, “Co-locating leisure and health is a natural step and will make it much

4 https://www.ukactive.com/news/invest-1bn-to-make-leisure-centres-the-new-nhs-frontline/
5 https://www.nhs.uk/Services/clinics/ReviewsAndRatings/DefaultView.aspx?id=122411
easier for our nurses, therapists and doctors to link in with exercise facilities which are critical to
healthy living.”6 All fine words but he fails to understand you can lead a horse to water but you
can’t make it drink! Berwick’s population has a greater than average elderly population; it is
unlikely they will take part in many of the facilities offered by the leisure centre. Again, the irony is
that the “gentler” activities such as indoor bowling are being removed.

Berwick’s population is also, on average, less well off and therefore unable to access the facilities
on offer. One major reason for the downturn in membership is the ridiculous all-site pricing. After
its introduction in 2016, while there was a minuscule increase in membership in Northumberland,
membership of the Swan Centre dropped 30% from 772 to 542.7 This is a far more important
problem to overcome than the proximity of the local health services if greater “wellness” is to be
achieved.

Health service provision

The list of services proposed in the 2018 Appraisal is, at best, vague. Below is a list of the
services that were in existence in 2014.8

Inpatient services
• For elderly medicine, stroke and orthopaedic rehabilitation and palliative care
• Urgent care focussed on minor injuries and assessment
• Diagnostics including X-Ray, ultrasound, barium and mobile scanners
• Physiotherapy, occupational therapy, speech therapy, podiatry and intermediate care
• Midwifery led maternity unit
• Pre-assessment and day surgical procedures
• Nurse-led chemotherapy service
• Extensive outpatient clinics and day hospital services as follows:
Outpatient services
• Audiology
• Bariatric
• Breast surgery
• Cardiology
• Colorectal surgery
• Continence
• Dermatology
• Diabetes
• Ear nose and throat (ENT)
• Elderly medicine
• Elderly mental health
• Endocrinology
• Endoscopy
• Inflammatory bowel syndrome
• Gastroenterology
• Gynaecology
• Multiple sclerosis (MS)
• Ophthalmology
• Orthodontics
• Orthopaedics
• Paediatrics
• Parkinson’s disease
• Plastic surgery
• Radiography – x-ray and ultrasound, CT and MRI scans
• Respiratory - lung function testing
6 https://www.northumbria.nhs.uk/massive-leap-forward-for-new-berwick-hospital/
7 https://www.northumberlandgazette.co.uk/news/leisure-memberships-increase-but-not-in-north-northumberland-1-8277413
8 NHFT Outline Business Case for Berwick Infirmary Redevelopment (2014)

• Rheumatology – including blood monitoring and podiatry

• Sleep
• Stroke review
• Syncope and falls assessment
• Telemedicine fractures
• Urology

Day hospital
• Ambulatory blood pressure
• Ambulatory ECG (heart monitoring)
• Blood monitoring and transfusions
• Dermajet (needleless injection)
• Drug infusions
• Flow rate/bladder scanning
• Synacthen tests
Since 2014, the services provided at Berwick Infirmary have been reduced. It is therefore
disingenuous for the 2018 Appraisal to state, “It is understood that the new hospital was intended
to provide the same services as existing with the potential to expand outpatient and diagnostic
services. The new facility will also provide space to improve integration between health and social
care services.”
Not so. The authors of the Appraisal have either not read the 2014 report properly or are phrasing
their document in order to obfuscate the earlier work's recommendations, which are:
“The clinical content of the scheme will maintain all of the existing services on the site and will
include:
• An inpatient ward
• Minor Injuries Unit
• X-ray and ultrasound with visiting CT and MRI trucks
• Day surgery and endoscopy
• A single maternity delivery room with a birthing pool
• Outpatients combined with day hospital and therapy services
• Oncology day care
• Main entrance and cafeteria
• Body store
• Estates and facilities support accommodation”
The reasons the 2014 report embraced an expansion of services in a new hospital is clear; the
remote location of Berwick. This remains the case.
By comparison, the services offered at Alnwick9 , a town of 8,000 (Berwick 12, 000) are:
• Minor injuries unit for walk- in patients with a variety of urgent but non-life threatening conditions.
• Planned and on-going care and rehabilitation including:
• Diabetes care
• Diagnostic tests (x-rays and scans)
• Elderly care
• End of life care
• Maternity services (Hillcrest)—midwifery-led unit for deliveries, pregnancy and ante-natal care
• Oncology (cancer) treatment
• Outpatient clinics in a range of conditions
• Surgery – day-case operations and procedures
• Therapies including physio, occupational and speech and language
Hexham (population 12,000) has a new general hospital with a great many services10 we can only
dream of. It was built under a PFI scheme but cost £51m. Since then, the NHFT have borrowed

9 https://www.northumbria.nhs.uk/wp-content/uploads/2017/05/NHS-Feb-1-final_merged8-2.compressed.pdf
10 https://www.nhs.uk/Services/hospitals/Services/DefaultView.aspx?id=1587
£114m from Northumberland County Council at a low rate of interest to pay off the private
contractors.11 Needless to say, both are much closer to Wansbeck, Cramlington and Newcastle.

The Hidden Costs

The table below demonstrates the return times and costs of travelling from Berwick to any other
hospital.

Hospital Distance (return, Travel time Cost (private) Travel time Cost (public,
miles) (return, private) (return, public) estimate)
(mins) (mins)

Wansbeck 110 144 £18.70 270 £21.00

General Hospital

Cramlington 118 142 £20.00 222 £21.00

Emergency Care
Hospital

Hexham General 160 180 £27.00 480 £30.00

Hospital

North Tyneside 128 180 £30.00 200 £21.00

General Hospital

Borders General 84 146 £14.00 480 £8.00

Hospital

Central 122 150 £25.50 200 £15.00

Newcastle
hospitals

A figure for the number of patients and visitors that have to travel to other hospitals is not known
but must be substantial. An excellent Patient Transport Service exists on a volunteer driver basis
but the cost of transport will be borne by the NHS. Berwick Cancer Cars also run an invaluable
voluntary service, funded by sponsorship and donations. There is also a limited visitor transport
service.
For the individual, a trip that may only necessitate a 10 minute consultation, will possibly require a
day off work or loss of earnings for that day. In addition to the financial costs are the emotional
costs, detrimental to the wellbeing of patient and family members.

11http://www.hexham-courant.co.uk/news/Hexham-hospital-deal-praised-by-Labour-leaders-8cf69a36-8057-4b71-
b2ae-361253b2cec2-ds