BEDS will be reduced and patients sent home earlier under proposals put forward as part of a major shake-up of county hospital services in a bid to cut spending by £20m a year.

A 'menu of options' identified by private management consultants who have been carrying out an urgent review of finance and services across Worcestershire Acute Hospitals NHS Trust also includes centralising obstetrics, gynaecology, paediatrics, A&E and cancer services at Worcestershire Royal Hospital.

This would mean the transfer of these services from the Alexandra Hospital, Redditch.

The Aconbury block at Worcester - which currently houses 96 beds mainly used for elderly patients and rehabilitation - could also be closed to save £2.1m.

And Finnamore Management Consultants has flagged up refinancing the PFI contract for the Royal for an extra five years to release £12m capital.

Three alternative routes through nine areas of potential savings have now been drawn up, saving between £22.8m and £27m.

Health chiefs say that the proposals - which the public will get a chance to have their say on - will not sacrifice patient safety and clinical standards. But staff expressed concern when they were confronted with the proposals this week.

Trust chief executive John Rostill told fellow board members yesterday: "In Worcester there was concern about whether we could transfer patients from Aconbury and still reduce the number of beds," he said. "In Redditch there was more concern and anxiety because their services seem to be more affected.

"Across the trust there was a general acceptance that this is going to be a huge challenge."

He added that it was important to understand that the examples of proposed service changes are not done deals.

"They are simply proposals which may or may not be put forward for formal consultation depending on our further analysis and discussions over the next few weeks," he said.

Trust chairman Michael O'Rior-dan said the trust is now entering a pre-consultation phase where anyone who has a valid contribution to make to the review can come forward with their comments and suggestions.

"We hope to be able to begin formal public consultation by early December - but before we have a package of options to put forward for that process, we have to make sure that our figures are accurate, our findings add up and we have cost-saving measures that can be implemented.

After receiving the report, board members agreed to press ahead with further detailed analysis of the findings, and to engage as fully as possible with patients, the public, trust staff, NHS colleagues and other key stakeholders before producing a final set of proposals which will go to formal public consultation.

THESE ARE PROPOSALS ON THE TABLE

This is the menu of options that is being proposed to make savings of £20m. All could be implemented in some shape or form.

l Productivity improvement - to reduce patients' length of stay; to reduce bed occupancy which will eliminate charges which currently are in force when the the trust runs at more than 90 per cent capacity; improving theatre use by 10 per cent and eliminating short notice cancellation of operations. Saving £16.3m.

Dr David Brownridge, GP at Drs DS Brownridge & A C Horn, Main Road, Ombersley said more patients being released early would put pressure on GPs and community nurses.

"GPs already feel that patients are released too early," he said.

l Reconfigure services - 'simple' or 'complex' options.

Simple (to save £1m) - centralise all inpatient obstetrics, gynaecology and paediatrics at Worcester, leaving outpatient and day case work on other sites, and 700 deliveries in 'northern' midwife led maternity unit.

Complex - (to save £5.2m) - as per simple option, plus centralising A and E, emergency surgical services, cancer surgery and critical care at Worcester.

l Site rationalisation - Close Aconbury block on Worcester Royal site; minimise under-usage at Kidderminster Independent Treatment Centre; rationalise services between Princess of Wales Community Hospital, Bromsgrove, and Alexandra Hospital in Redditch. Saving £2.1m.

l Repatriate ear, nose and throat work from Birmingham to Worcestershire. Saving £100,000.

l Improve income recovery. Key areas for focus will be haematology/oncology, A and E and outpatients. Savings estimated between £1m and £2.8m.

l Refinance PFI contract on Royal site for extra five years releasing £12m capital, or reduce payments by £100,000 a year.