Agenda item

(To receive a report on Grantham and District Hospital Accident and Emergency Department which invites the Committee to consider the implications of the report by the East of England Clinical Senate. Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust; Dr Neil Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust; John Turner, Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership, will be in attendance)

Consideration was given to a report by the Health Scrutiny Officer which invited the Committee to consider the implications of the report by the East of England Clinical Senate on the Review of Accident and Emergency Services at Grantham and District Hospital (United Lincolnshire Hospitals NHS Trust).

 

The Chairman welcomed Jan Sobieraj (Chief Executive, United Lincolnshire Hospitals, NHS Trust (ULHT)), Dr Neill Hepburn (Medical Director, ULHT), John Turner (Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership (STP)) and Jeff Worrall (NHS Improvement).

 

The report by the East of England Clinical Senate contained five recommendations as précised below:-

·       Recommendation 1;

o   The Panel did not support the reopening of the 24/7 A&E department at Grantham Hospital on the grounds of potential adverse impact on patient safety at A&E Departments at all three ULHT hospitals;

o   The Panel strongly recommended on the grounds of patient safety, that ULHT Trust Board reconsider the proposal to extend the current A&E service opening hours at Grantham and District Hospital; and

o   The Panel recommended that the Trust continue to provide an A&E service at Grantham and District Hospital on the current opening hours;

·       Recommendation 2;

o   The Panel recommended that in order to make it clear for patients and the public the type of service available at Grantham and District Hospital A&E Department, the Trust consider relabelling or renaming the department and ensure that it communicates this message widely.  It was also recommended that 'A&E Centre' not be applied to Grantham and District Hospital in any further model;

·       Recommendation 3;

o   The Panel recommended that the Trust should move to a single A&E team with a focus on standardised clinical pathways and processes across the three sites;

·       Recommendation 4; and

o   The Panel recommended that the Trust and CCG have clear alignment with the Lincolnshire STP, developing a system approach to urgent and emergency care, and planned care for patient and the public.  The Trust and STP should move to public consultation on an agreed future model as quickly as possible;

·       Recommendation 5;

o   The Panel recommended that ULHT work with the local CCG and STP to develop an enhanced communication and engagement strategy to ensure that all stakeholders, public, patients and locally elected representatives were given the opportunity to input on the development and decision regarding the final model for urgent and emergency care across the Trust's three sites;

o   The Panel recommended that the communication and engagement strategy develop plans to ensure that any changes to the designation, opening times and pathways related to emergency care provision were clearly communicated with the public, patients, stakeholders and staff both within the STP footprint and with surrounding STP footprints.

 

Jan Sobieraj (Chief Executive, ULHT) confirmed that the ULHT Board had considered the report by the Clinical Senate on 15 December 2017 and resolved to heed the expert advice and accept the key recommendations to maintain the current hours at Grantham A&E.

 

The Chairman advised that, in accordance with the County Council's Constitution, a request to speak had been expressed by:-

·       Councillor R Wootten (Lincolnshire County Council (Grantham North));

·       Councillor L Wootten (Lincolnshire County Council (Grantham East)); and

·       Councillor D C Morgan (South Kesteven District Council)

 

Following the accepted convention, speakers would be allowed up to three minutes to address the Committee.

 

Prior to inviting the speakers to address the Committee, the Chairman proposed the following motion, which was also circulated to Members:-

1.    The Health Scrutiny Committee for Lincolnshire notes that on 15 December 2017 United Lincolnshire Hospitals NHS Trust Board acted as the 'responsible' person in considering a proposal concerning the opening hours at Grantham and District Hospital Accident and Emergency Department including a proposal to re-open Grantham and District Hospital Accident and Emergency Department 24 hours per day seven days per week; and as a result the Board was considering a proposal for a substantial development of the health service or a substantial variation in the provision of such a service (in accordance with Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013);

2.    In accordance with Regulation 23(9)(a) of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, a referral be made to the Secretary of State for Health and Social Care on the basis that the Committee is not satisfied that the consultation on the decision by the United Lincolnshire Hospitals NHS Trust Board on 15 December 2017 not to re-open Grantham and District Hospital Accident and Emergency Department 24 hours per day seven days per week was adequate in both its content and the time allowed.

 

This motion was seconded by Councillor M A Whittington.

 

The Chairman invited Councillor R Wootten to address the Committee, during which the following points were noted:-

·       Several campaign groups and thousands of residents had signed petitions to reinstate the department 24/7, however the decision had still been taken to continue with the reduced hours despite appointing the required number of middle grade doctors;

·       Dismayed that consideration was also being given to rename the department;

·       The Committee was referred to the document 'Shaping Health for Mid Kesteven' and the response from ULHT reporting that there were no plans to downgrade the A&E Department at Grantham & District Hospital further suggesting that Grantham had a bright future as a hub for local healthcare services;

·       Having attended the Grantham Locality Forum, Councillor Wootten reported that 3000 residents had been consulted which was only 0.5% of the population of Lincolnshire;

·       The Leader of South Kesteven District Council had indicated his support for both Councillors and campaign groups in this matter and had written to the Secretary of State for Health and Social Care, MPs, ULHT, the Chairman of the Health Scrutiny Committee for Lincolnshire and the Leader of Lincolnshire County Council.  The letter outlined the strong feeling amongst campaign groups, residents and local councillors; and

·       Councillor Wootten fully supported the motion presented by the Chairman and the action proposed.

 

The Chairman invited Councillor L Wootten to address the Committee, during which the following points were noted:-

·       Councillor Wootten advised that she was speaking on behalf of residents of Grantham and surrounding villages;

·       Councillor Wootten had also attended the Grantham Locality Forum to discuss the ULHT 2021 Strategy and reconfiguration of estates and, although this looked favourable on paper, she was aware of the current special measures of ULHT and therefore was not convinced of the content;

·       Councillor Wootten felt it was demoralising for NHS staff to be constantly under surveillance and scrutiny and stated that the work of all the doctors and nurses providing care to residents was wholly appreciated and completely valued;

·       The Trust Board had taken the decision to close the department on the grounds of safety without proper consultation and now residents were faced with the STP despite the Council rejecting the STP in its current form;

·       If the department was not an A&E Department, it was questioned why the sign said it was;

·       It appeared that this department had been downgraded 'by the back door' and that there was no clear vision of the Trust or the CCGs for a way forward;

·       The principles of the STP appeared to be working against Grantham A&E even though thousands of residents, campaign groups and the Health Scrutiny Committee for Lincolnshire had voiced their concerns;

·       Grantham residents could not continue with this level of uncertainty and the Committee was urged to challenge the recommendations within the report of the East of England Clinical Senate; and

·       It was suggested that the Grantham estate could be reconfigured and utilised more, for example as a day care unit for elective surgery.

 

The Chairman invited Councillor D C Morgan (South Kesteven District Council) to address the Committee, during which the following points were noted:-

·       Councillor Morgan advised that her council seat covered some of the poorest areas in Grantham which houses approximately 120k people;

·       The department had been closed initially due to staffing issues and now the recommendations were to escalate this decision and to remove or amend the current signage;

·       The manner in which the work by the Clinical Senate was undertaken was questioned;

·       It was suggested that ULHT was under huge pressure to keep the unit closed due to the recommendations of the Clinical Senate who had severely underestimated the need for it;

·       Consultation had not taken place with local patient groups, nor did the senate challenge conflicting evidence from the Health Scrutiny Committee for Lincolnshire and ULHT; and

·       SOS Grantham Hospital had submitted a Freedom of Information request to find out the number of patients treated at Grantham A&E.  Contrary to the reports made by ULHT, the request indicated that 6700 critically ill patients had been admitted after they presented at the unit.

 

The Chairman thanked the speakers and invited Members to ask questions, during which the following points were noted:-

·       The Committee had been advised previously that 21 middle grade doctors were required to enable the department to be reopened overnight.  Once that level had been reached, the Committee was dismayed to learn that  NHS Improvement changed the number of middle grade doctors required, following advice from the East of England Clinical Senate Clinical Review Panel;

·       It was reported that it would have been irresponsible of ULHT not to act on the advice of the Clinical Senate Clinical Review Panel;

·       NHS Improvement confirmed that it was ultimately the Trust Board's decision but that the Trust also worked within an accountable system and would be expected to take proper account of any safety concerns.  It would be expected that any recommendations from the Clinical Senate would be heeded and, if not, NHS Improvement had powers to replace the Chair and members of the Trust Board;

·       Winter pressures had been incredibly hard this year which had put the NHS under considerable strain.  It was reported that plans were working, non-essential procedures had been reduced and staffing levels increased which had meant the system was relatively resilient;

·       Postcode activity of Grantham patients had been tracked as a result of the overnight closure and it was reported that the number of patients presenting at Lincoln was very small.  Hospitals in neighbouring counties had also been contacted and the number of patients from Grantham were so small that there had been no specific problems raised;

·       It was confirmed that long-term savings as a result of the closure had not been assumed and it was stressed to the Committee that the decisions taken at Grantham A&E had never been financially driven;

·       The Committee indicated that the Clinical Senate had not engaged people to enable them to consider and challenge the decision;

·       It had been previously reported that the reason for part-closure was due to clinical safety and the need to reach a level of 21 wte middle grade doctors before the unit could be reopened.  It was unclear why this issue had been passed to the Clinical Senate when that level of staffing had been reached;

·       The report of the Clinical Senate suggested that the situation to restore the overnight service at Grantham would result in an unsafe effect on the other units at Lincoln and Boston which could not be ignored.  There was a risk that the staffing level could reduce again which would result in the part-closure being reinstated thereby destabilising the service further;

·       NHS Improvement had recommended to the Trust that a Clinical Safety Review be requested, as part of which the Clinical Senate considered the change in the number of middle grade doctors required.  Mr Worrall confirmed that this was not the role of NHS Improvement.  Councillor Whittington asked that his dissatisfaction with this statement be noted within the minutes;

 

RESOLVED (Unanimously)

1.    The Health Scrutiny Committee for Lincolnshire notes that on 15 December 2017 United Lincolnshire Hospitals NHS Trust Board acted as the 'responsible' person in considering a proposal concerning the opening hours at Grantham and District Hospital Accident and Emergency Department including a proposal to re-open Grantham and District Hospital Accident and Emergency Department 24 hours per day seven days per week; and as a result the Board was considering a proposal for a substantial development of the health service or a substantial variation in the provision of such a service (in accordance with Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013);

2.    In accordance with Regulation 23(9)(a) of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, a referral be made to the Secretary of State for Health and Social Care on the basis that the Committee is not satisfied that the consultation on the decision by the United Lincolnshire Hospitals NHS Trust Board on 15 December 2017 not to re-open Grantham and District Hospital Accident and Emergency Department 24 hours per day seven days per week was adequate in both its content and the time allowed; and

3.    That a report be brought to a future Health Scrutiny Committee for Lincolnshire to present plans for the future of Grantham and District Hospital Accident and Emergency Department.

 

 

At 1.00pm, Mr B Wookey and Councillor R H Trollope-Bellew left the meeting and did not return.