Agenda item

Maternity Services


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 the success of this option would be the extensive difficulty the Health Service had in recruiting staff to west Cumbria.  They asked how the NHS was proposing to resolve this.


The Chief Executive of North Cumbria University Hospitals Trust said that the vision set out for rural and remote care was excellent, but the challenge now was around attracting young professionals and families to live, work and stay in the area.  This would be crucial to the success of the sustainability of Option 1.  The Chief Executive outlined a number of possible solutions to this, including:-


  • Permanent contracts
  • Less reliance on temporary/agency staff


Members understood the issues and the need to review the situation carefully after the 12 months period had elapsed, but they wondered if the substantial variation was agreed now, whether they would then get the chance to reassess this decision in 12 months time, if the decision was to implement Option 2 or 3.


The Chief Operating Officer for the CCG said that if after the 12 month period it was deemed that Option 1 was not a success the discussions about the implementation of Option 2 would be brought to the Health Scrutiny Committee for discussion.  However, he could not confirm whether this would be treated as a substantial variation.


On the basis that the CCG could not confirm this would be treated as an additional substantial variation it was proposed that this be referred to Secretary of State for health.


This was PROPOSED by Mrs Troughton and SECONDED by Mr Gill. 


The meeting was then adjourned for 10 minutes.


The meeting reconvened and the proposer outlined why members should refer this substantial variation to the Secretary of State for health on the grounds that the changes proposed are not in the best interests of the health service in the area.  Particularly:


  • The Committee were not given sufficient reassurance that the Committee would be able to have formal input into the Co-production Steering Committee and Independent Review Panel in developing the success criteria and its final recommendation as to whether option 1 is sustainable.
  • The Committee wanted to see but were not given a commitment that if the judgement is made that option 1 is not sustainable and option 2 or 3 were implemented after the 12 month period, this should be considered to be a different  substantial variation and treated accordingly.
  • The committee does not think that the travel impact assessment sufficiently reflected the geography of the area.
  • The impact assessment did not adequately reflect the shift in demand caused by an increase in ambulance call-outs.
  • The proposals for a dedicated ambulance were not sufficient to provide an adequate safe service.


This was then put to a vote, the results of which were:-


FOR - 10




The Committee then adjourned for lunch.