HEALTH chiefs are keeping all options open as a major review of the way hospital treatment and other services are accessed gets underway.

The future of woman's and children's services at Maidstone Hospital and emergency care at Maidstone Hospital are among several crunch issues back in the melting pot.

The upcoming debate forms the final part of a three-stage reform programme affecting patients, the wider public and staff across Maidstone, Malling and West Kent, which began in 2000.

The reforms aim to solve difficulties in recruiting specialist staff and meeting tough hospital performance targets, at Maidstone, Pembury and Tunbridge Wells.

They also form part of ongoing efforts to make Maidstone Hospital and Pembury Hospital centres of excellence for particular types of treatments.

Health bosses insist that the future of both acute hospitals at Maidstone and Pembury is secure but that in some areas urgent changes are required if standards are to be maintained.

Public consultation starts next month on the second stage of reform which include plans that will mean some patients needing to travel further for care.

Free buses linking the two sites are being considered. Out patient appointments and day cases will continue to be dealt with, wherever possible, at the nearest hospital.

If approved, the changes will initially only affect around 300 patients per year at Maidstone needing in-patient care but that figure could increase over time.

Proposals on the final stage of reforms need to be ready to meet the design brief deadline for the new acute hospital at Pembury, which needs to be completed by the end of the year.

These final reforms could include switching womans and children services, which include maternity, from Maidstone when the new £160m site opens in 2010. Further public consultation has been promised once these proposals are finalised.

Maidstone and Tunbridge Wells NHS Trust Chief Executive Rose Gibb said a decision on the issue had been "fudged" at the 1999 acute service review.

She said: "There is a big discussion to be had around women and children's services, which were never resolved back in 1999.

"There are problems here that will probably get bigger as we progress with time and we will have to review that during priority three, which is the final stage."

The construction of the new £1.7 million emergency medical centre at Maidstone would herald big changes in casualty care, the trust chief said.

There needed to be greater clinical assessment at the scene of accident and other incidents, to ensure people are directed to the right place.

With the opening of the new vascular centre at Medway it could mean, for example, heart patients in future being directed there instead of Maidstone Hospital's casualty department.

She said: "Accident and Emergency will never stay as it was. It will modernise. We need look at the totality of trauma care and what is best for the patient."