Our Health Our Care Programme - Update on the future of acute services in central Lancashire
Decision Maker: Health Scrutiny Committee
Decision status: Recommendations Approved
Is Key decision?: No
Update on the Our Care Our Health
The Chair welcomed Karen Partington, Chief Executive, Lancashire Teaching Hospitals; Dr Gerry Skailes, Medical Director, Lancashire Teaching Hospitals; Denis Gizzi, Chief Officer, Greater Preston and Chorley and South Ribble CCGs; Helen Curtis, Director of Nursing and Quality for the CCGs, Jayne Mellor, Director of Transformation for the CCGs, Dr. Sumantra Mukerji, Chair of Greater Preston CCG and Jason Pawluk, Our Health Our Care Programme Director, NHS Transformation Unit.
Jason Pawluk presented a report which provided an update from the Our Health Our Care programme on the future of acute services in Central Lancashire. This update described the progress made relating to the formal assurance process required by NHS England with regard to proposals for significant service change (stage 2).
The 13 options for service change for emergency care services for the residents of Chorley and South Ribble and Greater Preston CCGs being considered were distributed and are attached to these minutes.
Jenny Hurley, representing Protect Chorley and South Ribble Hospital from Cuts and Privatisation campaign group made deputations to the committee in response to the report. Jenny stated that the report didn't address downgraded services in other areas of Lancashire and didn’t take into account growing populations in the area. A question was also raised as to why other Hospital Trusts (Blackburn and Wigan) were getting new staff for their A&E departments and Lancashire Teaching Hospitals was not. The deputation requested a full analysis of the impact that a reduction of services would have and full public engagement at all stages of the process.
Members requested clarification on the areas detailed below:
· In response to a question it was confirmed that the first 'do nothing option' would leave services as they were now; the second option would leave services as they were in conjunction with a transformation of the acute services to improve efficiencies and the third option would increase accident and emergency provision at Chorley and South Ribble hospital to the requirements of a type 1 facility.
· Members requested assurance that the Our Health Our Care Programme would assimilate with the Integrated Care System (ICS) five year strategy. It was confirmed that the strategy was a set of proposals coming from the Integrated Care System and not a decision from it. However, the Committee was informed that Clinical Commissioning Groups (CCGs) were GP membership organisations and any constitutional proposals or request for change (including proposals to merge CGGs) would have to be endorsed by members. It was noted that a proposal to merge the two CCGs (Greater Preston and Chorley and South Ribble) in the central Lancashire area had been recently rejected by the respective CCG boards.
· Members asked what work was underway to engage with neighbouring health care services and hospitals, outside the central Lancashire area. It was confirmed that the Our Health Our Care Programme maintained a close working relationship with neighbouring CCGs and hospitals and were keen to work closely with them as with all the statutory consultees. NHS colleagues were aware of the concerns expressed by the chief executive of Wrightington, Wigan and LeighNHS Hospital Trust regarding the proposals. The proposed engagement timeline would align with the reduction of the range of the 13 options, when it would be easier to describe and understand what the impact on neighbouring services would be.
· In response to a question, Jenny Hurley stated that NHS digital applications had positive points, however she had examples where patients had been advised that a digital application was the only option. Jenny also maintained that GPs use applications that follow an algorithm to give the most inexpensive treatment pathway which didn't necessarily provide the best and most cost effective outcome for the patient.
· Members asked why the options didn't include plans to increase recruitment and training of staff, enhance service levels and improve patient access to GPs to reduce demand on accident and emergency services. Members emphasised that the options to close accident and emergency at Chorley and South Ribble hospital would see increased pressure on this service at other hospitals in West Lancashire, Blackburn, Wigan and Preston. A reduction or cessation of accident and emergency services in West Lancashire would create a gap in provision from Liverpool to north Preston. Concern was also expressed regarding the widely publicised lack of support for patients with mental health issues and how they are often reliant on acute services.
NHS colleagues confirmed that there were significant issues regarding staffing and there was not the resources to safely support the current level of provision. The service always strived to recruit to provide the correct workforce level. The aim was to try and work together to provide the optimum number of staff in the right places to ensure the correct pathways for patients. The objective was to provide safe quality care which couldn't be delivered with the current arrangements. It was stressed that this case for change was addressing accident and emergency services, however transformation was taking place across the whole remit of acute provision.
Members asked if the case for change was being considered due to lack of resources and investment in the NHS. It was clarified that difficulties in recruitment and retaining staff required the service to think differently about the continuum of care and how it can be provided using the resources more innovatively.
· Members commented that the option of building a new super hospital which had been mooted previously should still be an option. It was explained that the option of a super hospital was being explored but was not included in the 13 options as this couldn't be publically consulted on.
· Members highlighted that the traffic issues in and around the Royal Preston hospital site would need careful consideration, if the Chorley and South Ribble hospital accident and emergency service closed.
The Health Scrutiny Committee at its meeting scheduled on 3 December 2019, receive analysis on:
1. Staffing requirements for all options;
2. Impact on neighbouring Trusts as well as the Royal Preston Hospital site;
3. Mental Health service provision for all options;
4. Financial information on all the options.
Report author: Gary Halsall
Date of decision: 24/09/2019
Decided at meeting: 24/09/2019 - Health Scrutiny Committee