The preferred option would see A&E retained in Carlisle and Whitehaven, but the West Cumberland's intensive care unit would be smaller, with more patients transferred to the city's Cumberland Infirmary.
Another option is to completely remove A&E from the West Cumberland.
The Success Regime unveiled its detailed proposals at a launch event in Carlisle this morning, kick-starting a 12-week formal consultation which will run until just before Christmas.
Plans will then be finalised, with an announcement expected early in the new year.
The 56-page public consultation document includes at least two options for each service it wants to overhaul - maternity (including special care baby units), children's services, community hospitals, emergency care and stroke services. The Success Regime then states which option it recommends.
In summary, the options are:
1. Retaining consultant-led units in both Carlisle and Whitehaven, alongside midwife-led units. Special care baby unit would remain on both sites but some higher risk births would still go to Carlisle due to reduced paediatric expertise in west (as a result of proposed changes to children's services in Whitehaven)
2. Midwife-led unit only in the west with consultants on site 8am to 8pm. However these consultants would only provide antenatal and postnatal care, not help women actually in labour. All higher risk births would therefore have to take place in Carlisle. There is also a possibility of planned, lower risk caesareans taking place in the west in future. Plan also includes dedicated maternity ambulance
3. No births at all at West Cumberland Hospital, just antenatal and postnatal care. All women would have to travel to Carlisle to give birth.
Penrith birthing unit not affected by any of the options
1. Short stay paediatric ward at West Cumberland Hospital with some overnight stays for monitoring. All other children would go to Cumberland Infirmary in Carlisle
2. Short stay paediatric ward at West Cumberland Hospital but with no overnight beds. Dedicated in-patient unit created in Carlisle to serve whole of north and west Cumbria
3. Outpatient services only in west. No beds
(No option to retain all beds at all hospitals. All options are for 104 beds, which is less than now, and all propose closing beds at Alston, Wigton and Maryport, plus some others. Penrith would lose 4 beds in all scenarios)
1. Beds in Alston, Wigton, Maryport would close, with 104 beds consolidated across the remaining sites
2. Beds at Alston, Wigton, Maryport and Workington would close, with 104 beds consolidated across the remaining sites
3. Beds at Alston, Wigton, Maryport and Cockermouth would close, with 104 beds consolidated across the remaining sites
4. All community hospital beds would close, except in Penrith and Whitehaven's Copeland Unit (part of West Cumberland Hospital). Instead a new community hospital unit would be built in Carlisle. This would mean Brampton and Keswick also losing beds
In all scenarios, beds in Penrith would drop from 28 to 24. In options 1,2 and 3, Keswick and Penrith would gain extra beds
1. 24/7 A&E would be retained in both Carlisle and Whitehaven but West Cumberland Hospital's intensive care unit would be smaller, with more patients transferred to Carlisle
2. Daytime only A&E service at West Cumberland Hospital, supported by a 24/7 urgent care centre. More transfers to Carlisle and no overnight care for seriously ill
3. No A&E unit at the West Cumberland Hostpital, just urgent care services. Major increase in transfers to Carlisle
1. Existing service would be largely retained, with stroke patients taken to West Cumberland Hospital or Cumberland Infirmary
2. All stroke cases would be dealt with at a new specialist hyper-acute stroke unit in Carlisle. Only rehabilitation would be provided in the west
The majority of trauma cases are already dealt with at Cumberland Infirmary after being moved from West Cumberland Hospital without public consultation on safety grounds. Bosses now want to make this arrangement permanent, with some more minor procedures returning to Whitehaven.