Agenda item

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which sets out the Case for Change for Breast Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from the Healthy Conversation 2019.  Mr Jibril Jibril, Consultant Surgeon and Head of Service, United Lincolnshire Hospitals NHS Trust and Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group will be in attendance for this item)

Consideration was given to a report from the Lincolnshire Sustainability and Transformation Partnership, which set out the Case for Change for Breast Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from the Health Conversation 2019.

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group and Simon Hallion, Managing Director, Family Health, United Lincolnshire NHS Hospitals Trust.

The Committee was advised that United Lincolnshire NHS Hospital Trust (ULHT) was one of the largest breast services in the UK in terms of the total number of breast cancers treated by the service per year.  The Committee was advised that breast services were currently spread across ULHT sites with the majority of activity being serviced at Lincoln.  The Committee noted the performance as detailed on page 35 showed that for November 2018 to January 2019, performance against the two week wait standard had deteriorated.  It was noted further that patients diagnosed with breast cancer were being treated within the national 62 and 31 day waiting times standard, however, patients who were being referred into the service were having to wait too long to be seen; and receive their diagnosis. It was highlighted that the milestones in the NHS Long Term Plan would have an impact on breast cancers.  It was highlighted further that the strategy for Lincolnshire breast services had been developed using clinical guidelines for breast screening, diagnosing and treating breast cancer, together with the recommendations put forward in the NHS Long Term plan.

Page 38 of the report provided the Committee with details of the current service provision across the county.  The Committee was advised that there was a strong case for changing the way breast services were delivered in Lincolnshire, as a result of the number of patients being seen had increased; and that the model of care across ULHT hospital sites was inconsistent and did not always comply with clinical guidelines.  It was highlighted that the primary reason for this was because of the lack of breast radiologists and wider workforce issues.  It was highlighted further that there was a shortage of breast radiologist nationally.

Details of the two emerging options were shown on page 39 of the report.  As was details of the preferred NHS option, which was as follows:

·         Lincoln hospital to become a centre of excellence providing all first outpatient appointments (including the triple assessment appointment – consultation/imaging/biopsy) and day case and elective surgical procedures;

·         Screening mammography, follow-up outpatients and community support will stay the same and continue to be provided locally.  Mobile screening would also continue as it currently does; and

·         For those patients requiring a call back for further assessment, the assessment would take place at the centre of excellence at the Lincoln Hospital.

The Committee noted that oncological treatment for breast cancer i.e. chemotherapy and radiotherapy would continue as was currently provided.  The Committee noted further that the preferred option would establish a centre of excellence; improve multidisciplinary team assessment models and services to align delivery with the National Institute for Health and Care Excellence (NICE) guidelines regarding implementing a one stop shop diagnostic service; and also improve workforce sustainability.

It was reported that investment would be required to expand the breast unit at Lincoln Hospital.  The Committee noted that the capital funding required was estimated at £4.7m.  The Committee noted further that the funding source was still to be identified.

During discussion, the Committee raised the following points:-

·         The reduction of services at Grantham Hospital and the implications of the preferred option.  The Committee was advised that the preferred option still needed facilities in the local community which would continue to be provided.  Confirmation was given that any donations received, conversations would take place with the benefactor as to their specific request;

·         Some support was expressed to the Lincoln Hospital Site becoming a Centre of Excellence and to maintaining locally provided services for screening mammography, follow-up outpatients and community support services;

·         Some concern was expressed in relation to the financial investment required to expand the breast unit at Lincoln Hospital as a major risk, due the lack of identified funding, which was estimated as being £4.7m.  The Committee was advised that the current position was that £52m was required to make the changes necessary through the Acute Services Review.  However, steps were being taken to review the capital strategy; review NHS property and estates and their usage; and that this work would be on-going throughout the summer.  Alternative funding routes were also being explored;   

·         Clarification was sought regarding the impact to patients as a result of the preferred option.  It was reported modelling of patients who would be displaced to an alternative provider of breast services closer to where the patient lived, had indicated that 1,151 patients per annum would be displaced from the current ULHT Breast Service.  It was reported further that this equated to 22.7% of the current referrals into ULHT for suspected breast cancer and symptomatic breast issues.  Information was sought on the possible financial impact of patients who would be displaced to an alternative provider of breast services;

·         Due to the fragility  of breast services as a consequence of wider workforce issues, some members felt that consultation on breast services should be brought forward;

·         The need to ensure that the issue of transport was highlighted when considering the proposed changes.  A request was made for the joint transport strategy to be shared with the members of the Committee once it had been completed;  

·         A suggestion was made for further consideration on how Lincolnshire would access capital funding as part of the Sustainability and Transformation Partnership; and

·         A further suggestion was made for the Committee to consider workforce model as a future agenda item.

RESOLVED

1.    That the Breast Services – Case for Change and Emerging Option report be noted.

2.    That the Chairman be authorised to make a written response to the Lincolnshire Sustainability and Transformation Partnership regarding the case for change and emerging options for Breast Services.

3.    That the following information be requested by the Committee:

·         A copy of the Joint Transport Plan when completed;

·         Protocol on Patient Choice; and

·         Additional information on the possible financial impact of displaced patients to an alternative provider (as per 5:1 of the report).