Decision details

Chair welcomed Karen Partington, Chief Executive, Lancashire Teaching Hospitals NHS Foundation Trust, Jan Ledward, Chief Officer, Chorley and South Ribble and Greater Preston Clinical Commissioning Group (CCG) and Dr Dinesh Patel, Greater Preston CCG to the meeting to provide the Committee with the rationale for the decision to temporarily close the A&E department at Chorley Hospital and explain what the new temporary arrangements would be.

A PowerPoint presentation was delivered by Karen, a copy of which is appended to the minutes

A summary of the main points are outlined below.

Background:

·  Lancashire Teaching Hospitals Trust originally supported the application of the locum cap which was to encourage locums to apply to substantive posts

·  The cap was reported to be not in place in Scotland, Wales and Ireland

·  Recruitment into emergency medicine has begun to improve but were finding that nationally, 50% of doctors by year 4 were choosing not to continue in their roles

·  There continues to be a reliance on locums to support services and locums were reported to occasionally only provide 24 hours' notice to leave

Recruitment:

·  Now advertising vacancies through non-framework agencies as well as framework agencies.  (Framework agencies would complete all of the compliance checks prior to recruitment but for non-framework agencies, checks were required to be completed by the Trust)

·  North West Deanery have received a request from the Trust for evidence around allocation numbers of trainees to ensure the Trust are not being disproportionately disadvantaged

Service impact:

·  There was no reported impact on NWAS to date

·  An ambulance handover nurse was in place to alleviate previous challenges recognised on the timely transference of patients from the ambulances

·  Monitoring of Wigan, Bolton and East Lancs hospitals indicated minimal additional activity so far.  NWAS have confirmed that there were no patients taken to Southport and Ormskirk Hospital but would look to confirm status of their walk in patients

·  Emergency admissions have been equalised across the two sites with GP's referrals to Chorley, and emergencies through Emergency Department to Preston

·  So far there have been no significant fluctuations in attendance at RPH

Current position on recruitment:

·  Six gaps currently in the staff rota for Chorley Hospital A&E

·  Three locums have been booked for a period of supervision and trial before offering substantive posts

·  An additional two more locums booked and awaiting start dates 

·  One long term locum had already advised they were not available to work in  May and June

·  There have been 37 CV's reviewed and rejected as they did not meet the essential criteria with a further 17 CV's in the pipeline

Members were invited to make comments and raise questions and a summary of the main points arising from the discussion is set out below:

Members raised strong concerns around the staffing issues highlighted in the presentation and sought reassurances on what Lancashire Teaching Hospitals Trust were planning to do differently in the future and what the timescales to reopen were.  Members were advised that there was no information currently on timescales but were assured that they were working very hard to address the staffing gaps to reopen Chorley Hospital A&E. Further discussions would be taking place at the next System Resilience Group (SRG) meeting to identify staffing levels required. 

In addition to the work outlined in the presentation, Karen confirmed that they were also looking at how they could attract doctors from overseas and working closely with other organisations to respond to the recruitment issues. The locum situation was also looking more positive since the removal of the cap as it was reported that no CV's had been received for three months when the agency cap was in place.  Members were informed that the Trust worked together with partner agencies to hold the cap and initially were able to secure the level of staff required.  Two long term sicknesses tipped the balance and prompted the decision to break the cap.

Jan Ledward confirmed that the CCG was looking at care models and currently out to procurement for an urgent care service. This procurement exercise was due to close shortly and would be looking to mobilise this service towards the end of the year.

Karen advised members that RPH was a unique centre with all the specialist services in one place and they were building on that. In addition, a Health Academy has been launched and education plans were in place to assist with future recruitment.

Members were assured that the Trust did acknowledge that there was additional travelling time to RPH from the Chorley area.  Feedback was reported to be obtained from patients, family and friends on a daily basis around their experience of the service which could be published. 

It was highlighted that numbers accessing Urgent Care in Chorley were increasing and indicated a positive picture as it showed that more patients were accessing the right level of service.  The Urgent Care service at Chorley was confirmed to be open from 8am until 8pm.  This was agreed in line with current staffing levels which were insufficient to support longer hours.

Members requested reassurances that the temporary closure of Chorley Hospital A&E had nothing to do with the £14m overspend and that RPH had the capacity to support the additional patients as a result of this temporary closure.  Karen confirmed that the closure was a direct result of the inability to recruit the right level of doctors and was in no way connected to the reported overspend.

In relation to capacity at RPH, it was acknowledged that some patients would have to wait longer or maybe required to go elsewhere for treatment if there were more urgent cases.  Assessments were in place to ensure the right level of service was achieved for all patients attending RPH.  In addition, they worked with Lancashire Care Foundation Trust to determine a new model of urgent care to ensure patients were dealt with appropriately to free up capacity for the emergency doctors.

Members requested information on outcomes and whether the Trust felt that communication could have been handled more successfully.

Karen confirmed that Healthier Lancashire were looking at outcomes across Lancashire and South Cumbria and more locally, mortality statistics were available to flag up any issues of which the SRG have requested a review.  Data was also being produced around the impact and quality of care.

Communication has been ongoing through the SRG which included members from many partner agencies and NHS Improvement.  Karen conceded that communication could have been organised sooner but briefings had been completed with MPs and Leaders outlining issues as they arose. 

Members were assured that as well as communication with partners, conversations have been held regularly with Trust Chief Executives across the county and were briefed on the situation in Chorley.  They have also commenced a Chairs and Chief Executive meeting.

Resolved: The Committee:

1. Noted the current position provided by the Lancashire Teaching Hospitals Trust
2. To receive regular updates from the Trust with information on outcomes, impact and timed action plan with an indication of the date to reopen of Chorley Hospital A&E
3. To proactively seek the views from a range of partners and other sources to continue to scrutinise the current and future provision.
4. To receive minutes from the SRG meetings
5. To receive data showing the average number patients per hour at both Chorley and Preston