Agenda item

Consultation Implementation


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 this service.


Members had specific concerns about the provision of the consultant on call, the transfer of children out of hours and the safety of the children during travel without access to a paediatric professional.


The Chief Executive said the CCG would extend the scope of the MLU audit to include the changes to children’s services as determined by Option 1)


Some of the members had reflected on the proposals from the CCG and felt that they would be content not to refer this based on the reassurances from the Chief Executive.  However, not all members were in agreement with this.


The decision to proceed with this referral was then voted upon, 


FOR - 2




RESOLVED that members agree not to refer this substantial variation to the Secretary of State for Health.


68c) Maternity Services


The Chief Executive of the CCG gave members assurance that the output of the Co-production Steering Committee and Independent Review Panel would be fed back into the Health Scrutiny Committee.


There would be transparency of the work of the 2 groups.


The Co-production Steering Committee would decide if a member from the Health Scrutiny Committee could have a seat on the group.  The Chief Executive pointed out that there may however, be a potential conflict of interest of a member taking this seat


The Chief Executive said the CCG recognised that there were still unresolved differences in relation to the maternity option.


Members reiterated their concerns that 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.

The decision to proceed with this referral  was then voted upon, 


FOR - 6




RESOLVED that the substantial variation for Maternity Services be referred to the Secretary of State for Health on the grounds that the changes proposed were not in the best interests of the health service in the area.


d) Community Hospitals


The Chief Executive confirmed that medical beds would not close until the alternative models were in place (albeit there may need to be temporary closures for operational reasons in the meantime).  The Health Scrutiny Committee members recognised this.


The Pre-Consultation Business Case had within it a very significant shift of resources to support these developments.


The CCG re-iterated the strong support for these alternative models, which would have a significant positive impact on delayed transfers of care.


The Chief Executive gave members assurance that the CCG would continue to work closely with the council, respecting the governance arrangements around integrated commissioning that were already in place.


Members specifically asked for details on the proposals for the alternative to the medical beds, and what plans were being developed for this.


The Deputy Chief Executive of the Cumbria Partnership Foundation Trust outlined the proposals in more detail, including:-


  • Additional prevention for those with frailty issues
  • Recycling money and people
  • Public health issues – looking to free up investment to resolve issues such as obesity


Members were concerned about the difficulties with recruiting nurses at Alston Hospital, as the nurses would be crucial to the success of this.


The Chief Executive outlined the role the co-production group would play in this.  He felt that way in which decisions were taken to manage the community services effectively needed to be taken collectively.


Members asked how carers in the communities would be sourced in remote locations such as Alston.  The Deputy Chief Executive accepted that this would be challenging to achieve.


However, he felt that there was a real exciting opportunity to try to resolve these issues together, in partnership.  If the decision on Community Hospitals was delayed there was a very real possibility that enthusiastic people would be lost to the alliances.     


Members asked for the terms to be put in writing and sent to Health Scrutiny Members.  The Chief Executive of the CCG AGREED to action this. 


The decision to proceed with this referral was then voted upon, 


FOR - 3




RESOLVED that members agree not to refer this substantial variation to the Secretary of State for Health.