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

NHS Forth Valley has not had its troubles to seek over the past 18 months.

A string of critical inspection reports and mounting concerns over its ability to provide key services, such as GP out of hours, resulted in it being placed into 'special measures' with direct government oversight.

An Audit Scotland report last week warned that the health board was "not financially sustainable in the short-term" amid a £15 million black hole in its budget.

Now there are rumours that a question mark hangs over the future of the Women's Health Ward at Forth Valley Royal.

'The mood is bleak'

Bosses at NHS Forth Valley are currently in the process of developing a frailty unit at its Royal hospital in Larbert. This follows a directive from the Scottish Government to increase capacity for frailty-related admissions, such as elderly patients suffering falls or delirium.

A key objective is to reduce the amount of time these patients are spending in A&E, where their condition is prone to deteriorate.

The most recent statistics, for the week ending December 3, show that 28% of people who attended the emergency department at Forth Valley Royal spent more than eight hours there compared to a Scotland-wide average of 12%.

Improving the "flow" of patients out of A&E and onto a ward can only improve if capacity improves, which is where the extra frailty beds come in.

The downside is how to create these without impacting another, existing service.

The Herald: 28% of people who attended the emergency department at Forth Valley Royal spent more than eight hours there28% of people who attended the emergency department at Forth Valley Royal spent more than eight hours there (Image: Newsquest)
Sources have told The Herald that staff working in the Women and Children's Directorate had been told out-of-the-blue that Ward 6 – the Women's Health Ward – was to close, paving the way for the new frailty unit.

"The mood there is bleak amongst those who know about it," said one.

A spokeswoman for NHS Forth Valley insists that "no decision to relocate any services has been made" and that it is looking "at a number of options to help improve capacity and flow through the hospital, including the development of a frailty unit".

She added: "This work is still at an early stage and no changes would be made without ensuring that services can continue to be delivered safely and effectively."

The Women's Health Ward currently specialises in providing care for women recovering from miscarriage, termination, planned operations, emergency surgery for conditions such as ectopic pregnancy, and end-of-life care for gynaecological cancers.

If it were to close, those involved in running the service would be worried about the potential impact on patient safety and dignity.

Moving these women to the maternity ward could be one option, but there would not be enough space to accommodate everyone and the situation would result in women who were terminally ill or who had just lost a baby sharing a ward with new and expectant mothers and babies.

Read more:

However, the prospect of relocating the women's health service to somewhere further afield in the hospital – away from specialist medics – also raises alarm bells.

One source said: "Those of us with long enough memories of Stirling Hospital will recall a short lived move of the women's health ward away from the rest of the services which resulted in a woman dying and the changes reversed.

"The gynaecology emergencies this ward deals with rely on the doctors who cover both the maternity and gynaecology patients to be able to respond quickly, it's literally life and death to get some of these patients assessed and operated on.

"This move will make that more harder and colleagues working in the area are seriously concerned it is going to result in patients dying... [It] seems as if yet again women's health is seen as an easy target and something that can be kicked down the list of priorities, just because the board want to keep the government happy."

Elective care

A point often missed in the coverage of Forth Valley's poor A&E waiting times performance is one of the reasons why the hospital is so full: because it has continued to make elective care a top priority.

In comparison to other health boards, it has been less inclined to pre-emptively suspend elective work to free up beds for urgent admissions. At times, as inspectors noted, this has resulted in dangerously high occupancy rates, such as five beds being crammed into four-bay rooms.

Sign up for Inside the NHS and read our health correspondent every week in your inbox.


The flipside is that NHS Forth Valley, with a patient population of 306,000, has just 84 patients who have been waiting over a year for a planned procedure compared to 5,409 in NHS Ayrshire and Arran (patient population 376,000).

No one in Forth Valley has been waiting any longer than 18 months.