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NHS North Cumbria Clinical Commissioning Group’s (CCG) Governing Body met today to discuss and make decisions about the future of healthcare in west, north and east Cumbria.

The options were the subject of a public consultation between September 26 and December 19 2016.

The meeting considered recommendations developed from the options consulted upon, in light of the public feedback, and following subsequent clinical workshops.

The Governing Body decided:

Maternity

To implement and test the viability of Option 1. To maintain consultant-led care at the West Cumberland Hospital, with some high risk women giving birth in Carlisle. During a 12 month period there will be an Independent Steering Group established to involve the community working in partnership with health professionals (co-production) to enable the very best efforts to be made to tackle the challenges the service faces, particularly around recruitment and retention of key staff, especially in paediatrics and anaesthetics. An important element of this co-production work will be an independent review of anaesthetist recruitment in relation to maternity services undertaken by the Royal College of Anaesthetists as soon as is practically possible.

At the same time there will be the development of an alongside midwife-led unit at the West Cumberland Hospital. The unit will be assessed as though it were ‘free-standing’ to better understand the level of risk to expectant mothers and babies.

If Option 1 is not proven to be deliverable or sustainable then Option 2 should be implemented at the end of the 12 month period (Consultant Led Unit and alongside Midwifery Led Unit at Cumberland Infirmary Carlisle and a standalone Midwifery Led Unit at West Cumberland Hospital).

If following the audit of the midwife led unit, Option 2 is not deemed to be safe, then Option 3 should be implemented. (Option 3 is a Consultant Led Unit and alongside Midwifery Led Unit at  Cumberland Infirmary Carlisle and no births at West Cumberland Hospital).

Paediatrics

To implement Option 1. This option involves the development of an inpatient paediatric unit serving West, North and East Cumbria based at the Cumberland Infirmary in Carlisle along with a Short Stay Paediatric Assessment Unit. At the West Cumberland Hospital in Whitehaven there would be a Short Stay Paediatric Assessment Unit for children requiring short term observation and treatment. There would be some overnight beds at Whitehaven for children with less acute, low risk illnesses but children who needed more acute inpatient admission would be transferred to Carlisle.

The Governing Body agreed that if Option 1 ultimately proves to be unsustainable, then Option 2 for Children’s Services may need to be implemented. This would mean no paediatric overnight beds in Whitehaven.

Community Hospitals

To implement Option 1 which will see the consolidation of inpatient Community Hospital beds into six sites. In total there would be 104 inpatient beds at Whitehaven (Copeland Unit), Cockermouth, Workington, Penrith, Brampton and Keswick. However the Governing Body support this being implemented in a phased way through the proposals developed by the communities, in Alston, Maryport and Wigton, over the next few years.

Emergency and Acute care

To implement Option 1. This will see 24/7 A+E services maintained at both the Cumberland Infirmary in Carlisle and the West Cumberland Hospital in Whitehaven. An intensive care unit will be retained at Whitehaven, with the most seriously ill patients transferred to Carlisle. This option will also see the development of an innovative, ‘composite’ workforce model developing staff to cover a wider range of roles.

Hyper acute stroke services

To implement Option 2. This will see a hyper acute stroke unit (HASU) developed at the Cumberland Infirmary in Carlisle, with all possible stroke patients taken directly to the unit, and any arriving at Whitehaven transferred to Carlisle for assessment and treatment by a specialist multi-disciplinary team. Rehabilitation services will be maintained at the West Cumberland Hospital.

Emergency surgery, trauma and orthopaedic services

The Governing Body agreed to make permanent the earlier interim changes which saw the centralisation of emergency complex trauma and orthopaedic surgery at the Cumberland Infirmary.

This will also see more minor trauma surgery carried out at the West Cumberland Hospital along with some non-complex day case surgery. There will also be additional outpatients fracture clinics introduced at the West Cumberland Hospital.

NHS Cumbria CCG’s chief executive Stephen Childs said: “We have listened to the feedback we received during the public consultation. We have been very clear about the challenges we face and members of the public have shared their concerns about the risks. We hope we have found a way forward, but we will need the support of everyone – NHS staff, the community, the groups we have been engaging with throughout the process as well as other health professionals, to try to ensure safe and sustainable services into the future. The output of the independent review of anaesthetist recruitment to be carried out by the Royal College of Anaesthetists will provide further valuable insight.

“We know it won’t be easy, but we also know there is a great energy and passion for the NHS and we want to harness every opportunity to create the best outcomes for Cumbria.”

The Governing Body also found that the public consultation had been carried out to a highly satisfactory standard, meeting the independent Consultation Institute standards to be rated ‘best practice’.

It also outlined a process for ensuring that implementation plans are drawn up with appropriate staff, clinical and community engagement, and to ensure the new services are introduced safely.

The meeting was held at the Oval Centre in Workington and observed by members of the public, including health and local authority partners, and representatives of community and campaign groups who have been involved over recent months.

The decisions will be considered by Cumbria County Council’s Health Scrutiny Committee later this month.

Dr David Rogers, Medical Director of NHS Cumbria CCG, said: “Firstly we would like to reassure our community, patients and staff that no services will change overnight. Robust plans will need to be in place before any changes occur. We will need the community’s support to enable us to ensure the transition of these services safely over time. We have listened to both the public and the experts and do believe that a genuine coproduction is the best way forward  to ensure the best possible services for our patients and public’’.

“This process has been about ensuring safe and sustainable services for our community, and that continues to be our priority in the coming weeks and months.”

A spokesperson for NHS England and NHS Improvement Cumbria and the North East, said:

“The West, North and East Cumbria Success Regime, which was established in autumn 2015, had the very important and difficult task of looking at how to tackle long-standing problems within the health system in the area, with a focus on recruitment, finance and quality of care.

“We appreciate that changing the way people access health care may cause concern. Views from a vast number and range of organisations and individuals have been taken into account as part of the consultation and Cumbria CCG’s decision making process. With regard to maternity services, additional information from an independent review by the Royal College of Anaesthetists, due to take place during April and May this year, will provide further important detail to assist with the implementation of proposals.

“The priority has to be to secure the future of health care in Cumbria, and to ensure patients receive the best possible care, which is sustainable, safe and affordable.”

• Independent report into large-scale consultation published
• Report finds “mixed support” for proposals, with large sections of the public rejecting all options
• Clinical support for change and preferred options from many national and local experts
• NHS Cumbria CCG’s Governing Body to make decisions at 8 March meeting before its decisions are considered by the council’s Health and Scrutiny Committee

An independent report looking at responses to the Healthcare for the Future consultation on services across west, north and east Cumbria has been published today (24 February).

The report, from specialist consultation analysists The Campaign Company, provides an analysis of responses to potential changes to emergency and acute care, maternity and children’s services, stroke services, emergency surgery, trauma and orthopaedic services, and community hospital inpatient beds.

The report looks at responses from more than 5,000 people who shared their views on the options for consultation either online, or by filling in the survey in the consultation document or by writing in by email or post. It also analyses feedback from thousands of other people that took part in public meetings and other consultation activities.

Stephen Childs, chief executive of NHS North Cumbria Clinical Commissioning Group, said: “It is clear from the volume and the quality of the responses we received that people across Cumbria gave the issues very serious thought. Many people had clearly spent a lot of time writing their submissions, compiling information and pointing us to evidence they felt we should consider. I would like to say a huge thank you to everyone who took part in the process.

“It demonstrates that people care a great deal about their health and care services and that is a great endorsement of the NHS here and a compliment to the staff on the front line delivering services every day.”

Following an extensive pre-consultation engagement period, the Healthcare for the Future consultation took place between 26 September 2016 and 19 December 2016. The 12-week consultation saw 17 public meetings, and a large number of stakeholder update sessions, deliberative events, workshops and specific events for seldom-heard (or hard-to-reach) groups. It also saw the return of the Healthwatch ‘chatty van’, which visited locations across west, north and east Cumbria to ensure those in isolated communities would be listened to, engaging with more than 3,600 people. A further 1,000 people also took part in a telephone survey conducted with a demographically-balanced segment of the population across west, north and east Cumbria.

Looking into all of the feedback gathered from this activity, the report concluded that: “There is mixed support for many of the proposals outlined in the consultation document including the preferred options for the purpose of the consultation. Potential changes to services, particularly where loss of services are involved, understandably cause apprehension among those who may be affected. There has been clear and vocal opposition where this is potentially the case.”

However, a number of responses from both national and local clinical experts indicated support for either the preferred option or expressed the need for change from the status quo through any of the options presented.

Health leaders from across the system and NHS North Cumbria Clinical Commissioning Group’s Governing Body – who have already been considering public feedback from the consultation including any alternative proposals suggested by members of the public and community groups – will now review the findings of the report and consider these as part of its decision-making process.

The outcome of public consultation is an important factor in health service decision making. It is one of a number of important factors. Others include clinical, financial and practical considerations. The results of public consultation do not represent a vote on, or a veto over, any form of change.

NHS Cumbria Clinical Commission Group’s Governing Body will make a decision on the proposed services changes at its Governing Body meeting on 8 March. The meeting will be held in public at the Oval Centre in Workington. The decisions of the Governing Body will then be considered by Cumbria County Council’s Health Scrutiny Committee later in the month.

Read the executive summary of the independent report into consultation responses.

Read the full report.

A decision on the options considered as part of the Healthcare For The Future consultation is expected to be made in March 2017.

The consultation has looked at several key hospital services delivered in West, North and East Cumbria over the last 12 weeks and closes today (Dec 19^th).

The options were drawn up by NHS organisations working together through the Success Regime. NHS North Cumbria Clinical Commissioning Group (CCG) is the part of the local health system which has the statutory responsibility for consultation.

Over the last 12 weeks there have been 17 public meetings, and many more smaller sessions. People have been asked to share their views on the options for consultation online, or by filling in the survey in the consultation document or by making a personal submission to a Freepost address.

NHS Cumbria CCG’s Governing Body has carefully considered a timetable for decision making. Members feel it is important to make a decision as early as possible, but only if they are confident that public feedback has been thoroughly considered.

The public feedback is being analysed independently by The Campaign Company, and a report is expected in early February. Work will also be carried out to assess any alternative options suggested by members of the public and community groups. Local clinicians and regional specialists also will be involved in that process.

Health leaders from across the system and NHS Cumbria CCG’s Governing Body will also spend time considering the public feedback from the consultation process.

It is expected NHS Cumbria CCG’s Governing Body will make a decision in early March, ahead of the local government elections in May.

This will then be considered by Cumbria County Council’s Health Scrutiny Committee.

 

Ends 

Notes to Editors:

The Healthcare For The Future consultation closes at midnight tonight (Monday 19^th December 2016). Submissions made to the: Freepost ‘NHS Cumbria Consultation’  address will be accepted until 5pm on Friday 23^rd December 2016 to allow for any delays caused by the Christmas post.

At the recent public meeting at the Falcon Club in Egremont, there were some questions asked that we could not answer because our ambulance service representative was called away at the last minute. NHS representatives promised to confirm the answers to those questions so that they could be published online. Below are the questions and answers:

What plans are there for the air ambulance to fly at night?
There are currently no plans for night flying at present.

Could the dedicated ambulance vehicle (DAV) cover stroke cases as well as those for maternity and paediatrics?
Nothing is finalised as regards any of the options for maternity, paediatrics or hyper-acute stroke services. However, if option 2 for hyper-acute stroke services was chosen, hyper-acute stroke transfers would take place via an emergency paramedic ambulance, not a DAV, and would be a high priority. However, under this option we would expect the vast majority of patients to go straight to Carlisle from the community via ambulance; it would only be those who arrived under their own steam or were unrecognised by the ambulance who would be transferred.

Is the DAV driver going to be dropping people off home after hospital when not transferring between sites?
If the DAV is implemented, it will not undertake returns such as this. It may, if available, undertake local level inbound transfers to the midwife-led unit if not already tasked.