This article appears as part of the Inside the NHS newsletter.

Doctors in Ayr are becoming increasingly uneasy about the direction of travel for the region's medical services.

Some of those on the frontline have become convinced that the health board's leadership is engaged in a stealth plot to make its acute site, University Hospital Ayr, so unappealing to would-be recruits that they are forced to downgrade or even close it. The motive, as ever, being cost saving.

For its part, NHS Ayrshire and Arran flat out deny that the hospital is planned for closure, telling The Herald that this is "definitely not true".

So why have these concerns sprung up?

'Like taking the cardiac arrest trolley away'

A number of services already have, or are in the process of being, relocated out of Ayr hospital.

The one that has really set alarm bells ringing is the recent decision to transfer the three intensive care unit (ITU) beds operating at Ayr to University Crosshouse Hospital in Kilmarnock.

The health board's medical director, Dr Crawford McGuffie, insists that this is being done on an "interim basis" only – but senior clinicians are far from convinced.

Dr McGuffie said that it had become "increasingly difficult to sustain the current critical care service model on the University Hospital Ayr site due to significant difficulties in recruiting senior medical staff".

Major trauma has already gone to Crosshouse, vascular surgery to Hairmyres in Lanarkshire, and coronary care is also set to transfer to Crosshouse.

During the pandemic, inpatient cancer beds at Ayr were relocated to Crosshouse and its chemotherapy outpatient service moved into the Kyle Unit on the Ailsa hospital campus. Earlier this year, board members voted to make the changes permanent. The repurposed Kyle Unit, which also includes bed-based care and support services, means that 80% of all cancer therapy in the region is based in Ayr – just not at University Hospital Ayr.

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Losing ITU is perceived to be a major blow to the site, however, given the potentially far-reaching implications for staffing and services.

One medic told The Herald: "Taking ITU away is like taking the cardiac arrest trolley away – not used very often but necessary. If I were sick I would not want to go to Ayr Hospital and ambulances will bypass Ayr with sick patients."

Sources tell The Herald that impending closure of ITU at Ayr is already exacerbating staffing problems, with some ITU nurses finding jobs elsewhere – including outwith the NHS – and some consultants opting to retire.

As well as making it harder to attract anaesthetists and surgeons, the move is also expected to deter junior doctors who want to train in emergency medicine.

One doctor said: "No one is going to come and work in an A&E department that has no major trauma – that's an important part of junior doctor training. You're not going to get an Emergency Department (ED) trainee working where there's no ITU."

The Herald: A medic remarked, 'If I were sick I would not want to go to Ayr Hospital and ambulances will bypass Ayr with sick patients'A medic remarked, 'If I were sick I would not want to go to Ayr Hospital and ambulances will bypass Ayr with sick patients' (Image: Newsquest)

'No long-term plans to downgrade'

The fear among clinicians is that the A&E in Ayr will become unsustainable due to staffing shortages, forcing it to be downgraded to a minor injuries unit. The 200-bed Crosshouse would become the sole emergency and acute receiving site for the sickest and critically ill patients out of a population of 390,000 people.

Forth Valley Royal, with 443 acute beds for a population of 300,000, already struggles with the worst A&E waiting times in Scotland.

"They're going to let it fail and then say that it failed because of lack of staffing," said one clinician.

"It's predictable, and it will happen, but people aren't up in arms because they don't realise it's happening."

It comes as the health board, which is due to meet on December 4, grapples with a projected £50 million deficit in the current financial year, mainly due to overspending in acute services.

In a statement to The Herald, its chief Claire Burden insisted that it has "no long term plans to downgrade or close University Hospital Ayr" and is "committed to ensuring emergency care services are available from Ayr".

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She said: "We recognise and acknowledge that some of our teams and services have workforce gaps that put incredible pressure on the small teams left running services. We have escalated recruitment and will continue to do so."

She added: "We are eager to put to rest the rumours that University Ayr Hospital is planned for closure. This is definitely not true."