Venue: Conference Room A/B, Cumbria House, Botchergate, Carlisle. CA1 1RD
Contact: Lynn Harker Email: email@example.com
Apologies for Absence
To receive any apologies for absence.
Apologies for absence were received from Councillor M Cassells, Councillor V Rees and Councillor J Williams.
The Chair explained that the members travelling to the meeting from south of the county would be late due to the adverse weather conditions.
Membership of the Committee
To note any changes to the membership of the Committee.
It was noted that Ms J Riddle attended in place of Ms J Williams for this meeting only.
Disclosures of Interest
Members are invited to disclose any disclosable pecuniary interest they have in any item on the agenda which comprises
1. Details of any employment, office, trade, profession or vocation carried on for profit or gain.
2. Details of any payment or provision of any other financial benefit (other than from the authority) made or provided within the relevant period in respect of any expenses incurred by you in carrying out duties as a member, or towards your election expenses. (This includes any payment or financial benefit from a trade union within the meaning of the Trade Union and Labour Relations (Consolidation) Act 1992.
3. Details of any contract which is made between you (or a body in which you have a beneficial interest) and the authority.
(a) Under which goods or services are to be provided or works are to be executed; and
(b) Which has not been fully discharged.
4. Details of any beneficial interest in land which is within the area of the authority.
5. Details of any licence (alone or jointly with others) to occupy land in the area of the authority for a month or longer.
6. Details of any tenancy where (to your knowledge).
(a) The landlord is the authority; and
(b) The tenant is a body in which you have a beneficial interest.
7. Details of any beneficial interest in securities of a body where
(a) That body (to your knowledge) has a place of business or land in the area of the authority; and
(b) Either –
(i) The total nominal value of the securities exceeds £25,000 or one hundredth of the total issued share capital of that body; or
(ii) If that share capital of that body is of more than one class, the total nominal value of the shares of any one class in which the relevant person has a beneficial interest exceeds one hundredth of the total issued share capital of that class.
A “disclosable pecuniary interest” is an interest of a councillor or their partner (which means spouse or civil partner, a person with whom they are living as husband or wife, or a person with whom they are living as if they are civil partners).
Mrs G Troughton declared an interest under the Members Code of Conduct in relation to Agenda Item No 5 – Healthcare for the Future, as she worked as a volunteer with St John’s Ambulance Service.
Mr R Gill declared an interest In Agenda Items 5 – Healthcare for the Future, as his wife works at West Cumberland Hospital.
Exclusion of Press and Public
To consider whether the press and public should be excluded from the meeting during consideration of any item on the agenda.
RESOLVED, that the press and public be not excluded from the meeting for any items of business.
To consider a report by the Corporate Director – Resources and Transformation (copy enclosed).
Members considered a report from the Corporate Director – Resources and Transformation which outlined, for consideration by the Committee, the decisions made by NHS Cumbria Clinical Commissioning Group (NHS CCCG) Governing Body on ‘The Future of Health Care in West, North & East Cumbria’ proposals and as part of Stage 3 of the Committee’s Variation Protocol.
At its meeting of 24 February 2016 the Committee were advised that both the Success Regime and the NHS CCCG considered the expected proposals (referred to at the time as the Clinical Strategy) to be a substantial variation. Having consulted the chair of the variation sub-committee, the Committee agreed that they would be a substantial variation and agree to move to stage two of the protocol. At that stage the detail of the proposals had not been announced.
The Cumbria Variation Protocol stated that where the parties agreed that a proposed variation was substantial the Committee would provide comments/recommendations to the NHS Organisation which would then consider the comments and go out to consultation formally with the relevant stakeholders in accordance with the relevant legislation.
The Committee received an update from the Success Regime/NHS CCCG on the development of the draft clinical Strategy at its 13 April 2016 meeting and again at its meeting of the 16 May 2016. At these meetings the Committee had opportunity to make comments and recommendations about the proposals for public consultation, and consultation process itself.
The Committee requested:
These were all accepted by the NHS CCCG and incorporated into the consultation plan
At the 16 May meeting the Committee agreed that:
Stage 3 of the Variation Protocol stated that once the consultation had been completed the NHS Organisation would report the results of the consultation back to the Committee with its response and proposed next steps. If at this stage the Committee felt that the proposal would not be in the interests of the health service in its area, the Committee would then make a decision on whether or not to refer the matter to the Secretary of State.
The Senior Manager – Health and Care Integration explained to members that the circumstances for referral of a proposed substantial development or variation were laid out in legislation. That is, where a health scrutiny body had been consulted by a relevant NHS body or health service provider on a proposed substantial development or variation, it may report to the Secretary of State in writing if:
The Senior Manager – Health and Care Integration confirmed to members that this decision did not qualify as ground for referring to the Secretary of State for Health, on the basis that this had already been addressed at meetings of the Health Scrutiny Committee held on 13 April 2016, 16 May 2016 and 13 October 2016..
Representatives from the CCG outlined to members the significant, extensive public, patient and partner engagement work that had been undertaken prior to the Success Regime. He advised that the Success Regime had continued this work by holding over 170 public, private stakeholder and staff meetings, making 86 location visits and capturing the views of more than 3,400 people throughout the engagement process.
Members were also reminded that in order to ensure compliance with its statutory requirements, the CCG had kept the Cumbria Health Scrutiny Committee informed throughout the process.
The results of the public consultation were independently analysed by The Campaign Company and a final consultation report was received on 27 February 2017. This report could be viewed on the CCG website, if required.
Members confirmed that they felt the CCG had met its statutory duties in ensuring that a robust public consultation had been undertaken.
RESOLVED,that members agree that this decision did not qualify as ground for referring to the Secretary of State for Health, on the basis that this had already been addressed at meetings of the Health Scrutiny Committee held on 13 April 2016, 16 May 2016 and 13 October 2016.
The Chief Executive of the Cumbria Clinical Commissioning Group advised that the options for Maternity and Children’s services were inter-related. He confirmed that the preferred option for Children’s Services in the Consultation Document was Option 1. He then provided an overview of the findings of the consultation highlighting the following:-
The Chief Executive explained why the current service model did not present an attractive option to newly qualified Paediatricians. He felt that there needed to be a pathway for Paediatricians to come to Cumbria that included training in specialised areas. In addition he advised that if there was a commitment to encourage people to apply for jobs in the west of the County then there needed to be a network put in place that would allow them to bring their families and to fully commit to the area.
The Chair invited members to ask questions or make comments on the proposals.
Members asked if children would automatically be transferred to Carlisle if they presented to the West Cumberland Hospital after 10pm.
Dr Harpin replied that by and large this was what was proposed, however, if paediatric attention was necessary then a paediatric consultant would be ‘on call’.
Members asked if children would be subject to night time transfers. In response the Director of Strategy at North Cumbria University Hospital Trust replied under normal circumstances night time transfers would be avoided wherever possible.
One of the members asked how the deprivation of liberty applied to vulnerable children who could not have their parents with them. The Medical Director explained that the deprivation of liberty laws around vulnerable children doesn’t apply unless under special circumstances. If there were special circumstances then the NHS already had procedures in place to deal with this.
Members were deeply concerned about the impact transferring this service to the Cumberland Infirmary would have on the North West Ambulance Service and whether they would have sufficient capacity to deal with the extra transfers.
The Chief Operating Officer from the CCG confirmed that modelling had been undertaken and additional capacity, based on this, would be implemented.
The Director of Operations from the North West Ambulance Trust explained that a strong recruitment process was taking place to match staff to the requirements of the service going forward. Dedicated ambulances would be used for transfers for both children’s services and ... view the full minutes text for item 68b
The Chief Executive of Cumbria Clinical Commissioning Group stated that the preferred option in the Consultation Document for Maternity Services had been option 2, ‘The consolidation of a consultant led unit at Cumberland Infirmary, Carlisle (CIC) and the establishment of a midwifery led unit at West Cumberland Hospital (WCH)’.
However, the lack of support from the public and West Cumbria GPs for Option 2, was carefully taken into account, and considered alongside the support for this option from the professional bodies, NHS organisations and some consultants. There were concerns about the long term deliverability of Option 1, however, it was acknowledged that it was the strong preference of both the public and GPs. The Clinical Workshop advised system leaders to take further opportunities for transformational change that would support Option 1, but to be in a position to implement Option 2 or 3 should Option 1 not prove possible to sustain. In addition Option 1 should proceed on the basis of a collaborative, ‘co-production’ model, akin to that suggested by West Cumbria Voices.
The Chief Executive of the CCG said the NHS had listened to the public concerns raised for Option 2 and there was a firm commitment to ensure Option 1 was sustainable.
The Chair asked who would decide after the 12 month period whether the option was actually sustainable. The Chief Executive of the CCG said and Independent Review Panel would determine whether the criteria had been met for Option 1, but that ultimately it would be decision for the CCG Governing Body to take.
Members of the Cumbria Health Scrutiny Committee sought assurance that there was a real commitment from all partners to test the viability of this option over the proposed 12 month period. They were concerned that 12 months was not long enough to work through actions supporting the recommendations.
In response, the Chief Executive advised that there would need to be a genuine recognition of what could be done in terms of recruitment, this would need to be undertaken in an open and transparent process through the Co-production Steering Committee which would determine the criteria to achieve this.
Members asked whether it would be possible for an elected member to join the Co-Production Group. The Chief Operating Officer of the CCG said this was still work in progress but that the group was keen to engage with members and other interested stakeholders on this. However, there was a genuine wish for the process to be seen as open and transparent, and members would not be excluded from this.
Members had concerns that if after 3 months Option 1 was proving not to be sustainable that the CCG would just move to Option 2 without consulting partners/stakeholders about this.
The Chief Executive of the CCG said the criteria and milestones would be devised with the Independent Chair and the Independent Review Panel. However, everyone concerned wanted to ensure that Option 1, the preferred option, remained viable.
Members felt that one of the crucial factors to ... view the full minutes text for item 68c
The Chief Executive of the CCG outlined the key themes that had emerged from the consultation feedback, which included:-
· accessibility and patient safety;
· resourcing and quality of care;
· a clear case made for retaining the community hospitals, and
· concerns of a financial, economic and social nature
He explained the overall consideration of the options in light of the consultation feedback and referred to the following:-
· the major challenge in recruiting and retaining staff
· the limited prospects for staff in small isolated units
· the operational difficulties when trying to rota small numbers of staff, and
· the challenge of meeting clinical standards as set out by the National Institute for Health and Care Excellence.
Therefore the Success regime considered it important to have in-patient units with at least 16 beds where possible.
The Chief Executive confirmed that although the primary focus of the communities had been to defend bed closures, there had been some very innovative proposals for the future roles of community hospitals and differing services they could provide. These had been co-produced by Cumbria Partnership NHS Foundation Trust working with the public stakeholder groups such as the Hospital League of Friends and the local GP practices in each of Maryport, Wigton and Alston.
Members reminded health colleagues of the need to be mindful that community hospitals were considered an integral part of their community and removing them would be seen as diminishing those communities.
The Chief Executive made members aware that the workforce position in Community Hospitals, and especially in Alston, was very fragile and that it may become necessary for bed closures even in the shorter term due to difficulties in sustaining safe staffing levels. He also acknowledged that bed closures were likely to continue happening on an un-planned basis because of the on-going staff recruitment and retention challenges.
The Deputy Chief Executive of Cumbria Partnership Foundation Trust said Cumbria County Council had been engaging and was keen to work with stakeholders on the development of business cases for the proposals from Alston, Maryport and Wigton.
The Director of Service Improvement from NCUHT outlined the work that had been undertaken in Maryport. He had facilitated the co-production work there and there were some really exciting and innovative ideas coming through. There were 3 main proposals that had come forward from this group and a business case for these had already been produced. However, further work was still needed for Alston and Wigton.
Members referred to page 87 of the document pack where it stated that the conversation had moved from community hospital beds in Alston to finding a sustainable, affordable health and care model for the most remote town in England. This would imply that there were 2 equal partners in these discussions but members did not feel this was the case. They asked for clarity of the evidence in recommendation for the community hospital bed base and how would the impact for the removal of the beds be assessed.
The Director of Strategy from NCUHT said although ... view the full minutes text for item 68d
Emergency and Acute Care
The Chief Executive of Cumbria Clinical Commissioning Group advised that section 10 of the Decision Making document sets out the options consulted upon with Option 1 being the preferred option.
He stated the consultation also heard public concerns regarding early access to critical care, how uncertainty and low morale were affecting recruitment, the desire to retain an intensive therapy unit at West Cumberland Hospital and the need for a full risk analysis to be undertaken.
Themes arising from organisations, clinicians and professional bodies included the need for ongoing public and clinical engagement, the need to adhere to national policy and clinical guidelines, and some concerns about medical training in the context of a composite workforce.
During the consultation North West Ambulance Service raised concerns around transfers and operating protocols but had subsequently confirmed the deliverability of the preferred option.
The Chief Executive explained the reasons as to why the status quo was not put forward as an option. Those reasons included:-
The Chief Executive of North Cumbria University Hospital Trust said that NCUH NHS Trust had made significant progress in improving emergency care at both Cumberland Infirmary Carlisle and West Cumberland Hospital, but that further improvement was still required.
The programme had benefited from external support from the Clinical Senate in developing an innovative workforce solution. It was felt that the preferred model actually addressed many of the concerns raised during consultation, principally because the vast majority of care would continue to be delivered locally.
RESOLVED that this decision not be referred to the Secretary of State for Health
Hyper-Acute Stroke Services
The Chief Executive of Cumbria Clinical Commissioning Group advised that section 11 of the Decision Making document provided an overview of the options consulted on and that Option 2 was the preferred option.
Responses from the public included some recognition of the benefits of a Hyper-Acute Stroke Unit and delivery of rehabilitation as close to home as possible. Concerns about early access to services (and reference to a ‘Golden Hour’) and the need for a full risk analysis had been raised.
The themes from organisations, clinicians and professional bodies included:-
The Chief Executive advised that some stakeholders suggested that initial diagnosis and treatment would be undertaken at West Cumberland Hospital before transferring to Cumberland Infirmary Carlisle.
He confirmed that NHS organisations strongly supported Option 2 and following the close of the consultation, North West Ambulance Service had confirmed deliverability of the preferred option but in the context of additional capacity required.
The Chief Executive asked members to note that the key measure of access for a stroke was not the ‘Golden Hour’ but to receive thrombolysis within 3 – 4 hours. This standard was deliverable in terms of travel time for all parts of West, North and East Cumbria.
The Chief Operating Officer from the Cumbria Clinical Commissioning Group explained that the clinical evidence showed that a Hyper Acute Stroke Unit would improve outcomes for everyone. This included patients who do not receive, but would have benefitted from, thrombolysis. This was due to the presence of specialist Physicians, Nurses, and Therapists working in a single unit seven days a week, providing highly skilled specialist care. He also explained that current thrombolysis rates at both West Cumberland Hospital and Cumberland Infirmary Carlisle were very low.
Although members welcomed the introduction of a seven days a week service they again had concerns about the ability of the Ambulance Service to cope with the additional services being placed upon it, especially as target levels for ambulances were already below average in West Cumbria.
RESOLVED that this decision not be referred to the Secretary of State for Health
Emergency Surgery, Trauma and Orthopaedic Services
The Chief Executive of North Cumbria University Hospital Trust described the proposal in the consultation to make permanent the interim changes previously made on safety grounds. The consultation included the proposal to return some emergency surgery and trauma care to return to West Cumberland Hospital.
During the consultation an alternative model was proposed which entailed 24 hour emergency care, excluding major trauma, at West Cumberland Hospital with consultant led care 8 till 8, 7 days a week for medicine, surgery, trauma and orthopaedics and gynaecology.
The Chief Executive advised that the alternative model was considered, and that a number of issues arose indicating the challenge of maintaining two surgical teams, with low volumes of activity, safety, viability and sustainability concerns.
He assured members that the Trust was committed to the repatriation of services to West Cumberland Hospital, and that to date over 2,000 more procedures had been undertaken at West Cumberland Hospital, of which around 700 to 750 had been emergency procedures.
Members again had concerns about the capacity of the Ambulance Service to be able to continue to provide these services.
The Director of Operations from North West Ambulance Service said an independent survey had been undertaken for this service and he was confident the right number of vehicles would be matched to need.
RESOLVED that this decision not be referred to the Secretary of State for Health
The Senior Manager – Health and Wellbeing confirmed to members that this decision did not qualify as referring decision that could be referred to the Secretary of State for Health, on the basis that this had already been addressed at meetings of the Health Scrutiny Committee held on 13 April 2016, 16 May 2016 and 13 October 2016.
Health Scrutiny Committee members had serious concerns about the ability of the Cumberland Infirmary to cope with all the service being transferred from West Cumbria. The hospital was struggling now with capacity issues and his would only be exacerbated once the additional services were transferred over.
The Chief Executive of NCUHT accepted that the Cumberland Infirmary was not currently fit for purpose, and he outlined the proposed plans to address this, including the creation of an ‘emergency floor’.
Members also had concerns about the capacity of the North West Ambulance Service to cope with all the additional journeys, and sought assurance that the cumulative impact of these changes had been fully considered and that funding was in place to deal with capacity issues.
Health colleagues confirmed this was the case.
RESOLVED,that members agree that the implementation would not be considered as a substantial variation.
The Chair thanked the Health Scrutiny Members and Success Regime colleagues for the informed discussions. He then explained that the variation protocol sets out the requirement for a resolution procedure if the committee decided to refer a decision to the Secretary of State. With the agreement of the CCG, if necessary the resolution procedure would be undertaken within an adjournment once all the decisions had been considered.
The Lead Health Scrutiny Members and the Clinical Commissioning Group would meet separately to discuss the disagreement in further detail. The Committee would then reconvene immediately after this on the 22nd to consider the outcome of the resolution process and then make a further decision about whether to refer the decision to the Secretary of State.
The Chair reminded all members of the process and asked them to stay.
The meeting was then adjourned.
The meeting reconvened with the following members present, Mr N Hughes, Mr J Lister, Ms J Riddle, Ms V Taylor, Mr A Toole, Mrs G Troughton, Mrs C Wharrier and the Chief Executive of the Cumbria Clinical Commissioning responded back following the dispute resolution as follows:-
68b) Children’s Services/Paediatrics
The Chief Executive confirmed that the CCG would commit to work actively on these three areas (travel, shift in demand and safety of the Dedicated Ambulance Vehicle) to better understand the implications for travel with a view to acting to mitigate any adverse impact.
Members had concerns that if they chose not to refer this at this stage to give time for the CCG to mitigate any adverse impact then the opportunity would be lost.
The Chief Executive asked members if there was anything the CCG could do to prevent the referral as they wanted to try to mitigate any further delays to the development of ... view the full minutes text for item 68h
Date of Future Meeting
To note that the next meeting of the Committee will be held on Wednesday 24 May 2017 at 10.30 am at County Offices, Kendal.
The next meeting will be held on Wednesday 24 May 2017 in County Offices, Kendal at 10.30 am.