Agenda item

Children's Services/Paediatrics


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:-


  • much of the qualitative feedback related to the safety of young patients as well as the impact on family members and carers – again location and distance from services were a major factor
  • the view from the public that uncertainty around service provision had undermined recruitment, concerns expressed around the deterioration of children being transferred from West Cumberland Hospital to Cumberland Infirmary Carlisle and the impact of having to travel could have on some families
  • organisations, clinicians and professional bodies felt there was a need for ongoing public and clinical engagement, a need to adhere to national policy/clinical guidelines, and there was a mixed response on the sustainability of current services


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 maternity services, and contingency plans would also be in place if additional services were needed, such as private providers.


Scrutiny Panel members were concerned to hear that the dedicated ambulances would be a shared service between children’s services and maternity services, as this was not what they had been led to believe.


The Chief Executive of NCUHT explained that the use of a dedicated ambulance shared between children’s services and maternity services did not apply in the case of maternity Option 1, which was the preferred option.


Members asked whether the private providers would be fully trained and whether the vehicles would be sufficiently stocked.  The Director of Operations said all private providers would be CQC registered, and the vehicles would carry a full stock of provisions.  He emphasised to members that the private providers would only ever be used in emergency situations.


Members had a number of concerns about children being 40 miles away from their families, not least, that this may prove to be an extremely costly service.  When children were poorly surely the need was greater for them to be near their families.


The Director of Strategy at North Cumbria University Hospital Trust explained that work had started with colleagues in Healthwatch to look at possible solutions to this issue, such as shuttle buses, and help with accommodation, or even help into other services.


The Chief Executive of NCUHT reminded members that the service being scrutinised was only the service for acutely ill children and the need for the correct systems to be in place when needed.   There were already a number of transfers taking place between West Cumberland Hospital and the Cumberland Infirmary, and also the Cumberland Infirmary and Newcastle.


Members asked why no impact assessment had been carried out for public transport services.


Health colleagues explained that a comprehensive baseline assessment had been carried out for non emergency options, but there were still some gaps for emergency options.  An Action Plan was being developed to take this forward, however, she reminded the committee that the NHS was not responsible for public transport gaps.


Members also had concerns about the affect of the proposals on the Ambulance Service.  If there was no A&E service available this may result in many parents simply calling for an ambulance instead of visiting the A&E department.  This needed to be carefully considered as part of the impact assessment.   


Members proposed that this should be referred 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. 


This was PROPOSED by Mrs Wharrier 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 think that the travel impact assessment does not sufficiently reflect 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 are not sufficient to provide an adequate safe service.


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


FOR - 8