Agenda item

The Chairman advised that further to the announcements circulated as part of the agenda, the following supplementary information was circulated at the meeting for the Committees consideration:-

United Lincolnshire Hospitals NHS Trust Grantham and District A & E Department – Additional Information

That the United Lincolnshire Hospitals NHS Trust (ULHT) Board was meeting on 15 December 2017 to consider a report on the opening hours of Grantham and District Hospital's A & E Department, which was currently closed each night between 6.30pm and 8.00am.  The Committee was advised that further information had been published on 12 December 2017, which included reference to the details as shown below:-

Decision of ULHT Board on 7 November 2017

On 7 November 2017, the ULHT Board had agreed that it wanted to re-open Grantham and District Hospital A & E Department overnight, pending an independent review of staffing by NHS Improvement, the national regulator of provider trusts.  NHS Improvement asked the East of England Clinical Senate[1] to undertake a safety review for all ULHT's A & E Departments and to see whether the opening hours of Grantham and District Hospital A & E Department could be extended. 

Recommendations of the East of England Clinical Senate

In order to undertake the review, the East of England Clinical Senate had appointed a Clinical Review Panel, whose report had been published and contained the following five recommendations:

Recommendation 1

·         The Panel does 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 United Lincolnshire NHS Trust Hospitals.

·         The Panel strongly recommends, on the grounds of patient safety, United Lincolnshire Hospitals NHS Trust Board reconsider its proposal to extend the current A & E service opening hours at Grantham and District Hospital.

·         The Panel recommends that the Trust should continue to provide an A&E service at Grantham and District Hospital on the current opening hours of 08.00-18.30, seven days a week until a more definitive long term urgent and emergency care plan was developed and agreed.

Recommendation 2

The Panel recommends 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 look to re-labelling or re-naming the department, and ensure that it communicates that widely. The panel further recommended that the terminology ‘A & E Centre’ is not applied to Grantham and District Hospital in any further model.

Recommendation 3

The Panel recommends that the Trust should move to a single A & E team with a focus on standardised clinical pathways and processes across the three sites, removing any unnecessary variation and providing enhanced training opportunities.

Recommendation 4

The Panel recommends 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

·         The Panel recommends that United Lincolnshire Hospitals NHS Trust works with the local the CCG and STP to develop an enhanced communication and engagement strategy to ensure that all stakeholders, the public, patients and local elected representatives have an opportunity to input on the development and decision regarding the final model for urgent and emergency care across the Trust’s three sites, and not only for the Grantham site.  

·         The Panel recommends 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 are clearly communicated with the public, patients, stakeholders and staff both within the STP footprint and with surrounding STP footprints.

Advice of NHS Improvement

In a letter dated 5 December 2017, NHS Improvement had strongly advised the ULHT Board to follow the recommendations in the Clinical Senate's report.

Recommendation to the Trust Board

The recommendation to the Trust Board on 15 December 2017 is that it accepts the conclusions reached by the East of England Clinical Senate and follows their recommendations, which have been supported by NHS Improvement. 

The Next Steps

The Committee was advised that it was planned to programme an item for the Committee's next meeting on 17 January 2018, which looked at the implications of the Clinical Senate's report and the ULHT decision.  In addition to representation from ULHT at that meeting, representatives from the CCGs and NHS Improvement would also be invited to attend. 

The Chairman invited the Committee to comment and raise any issues.  The following issues were raised:-

·         Some members expressed their disappointment at the decision of the East of England Clinical Senate appointed Clinical Review Panel; and welcomed that the Committee would be considering the matter further at the 17 January 2018 meeting;

·         Some concern was expressed to the distance being travelled by patients to Lincoln, and whether the decision makers had taken into consideration the rurality of Lincolnshire;

·         One member expressed disappointment that the Secretary of State had referred the matter for local determination;

·         The impact of the uncertainty surrounding Grantham and District Hospital A & E Department was having on the recruitment of medical staff;

·         One member suggested that a response should be made to United Lincolnshire Hospitals NHS Trust asking them not to make a decision on 15 December 2017, but to defer the item to their next meeting to give the Health Scrutiny Committee for Lincolnshire the opportunity to scrutinise the item at the 17 January 2018 meeting.  A suggestion was also made for representatives from NHS Improvement, United Lincolnshire Hospitals NHS Trust, the Clinical Commissioning Group and the East of England Clinical Senate being invited to attend the 17 January 2018 meeting;

·         A question was asked as to whether there was a substantial variation; and if there was could the matter be re-considered by the Secretary of State; and as a result would that stop the matter from progressing.  The Health Scrutiny Officer advised that there had been no change except for an additional opening hour, which the Committee were aware of.  It was therefore felt that this would not stop the matter from progressing;

·         Concern was expressed to the changes to the establishment numbers required, in that the number of middle grade staff required had increased from 28 to 38; and

·         Some concern was expressed to the fact that if the Committee agreed to the East of England Clinical Senate recommendation 1 that this would prejudice any future consultation on A & E Services at Grantham and District Hospital; and to the fact that the current restricted opening hours would in effect be made permanent; and that the consultation exercise would be based on these opening hours as the status quo, rather than the previous 24/7 service.

RESOLVED

1.    That the Health Scrutiny Committee's disappointment with the recommendations of the East of England Clinical Senate report (Review of Accident and Emergency Services at Grantham and District Hospital – Report of the Independent Clinical Review Panel – 22 November 2017) be recorded.

2.    That the Health Scrutiny Committee's opposition to the first recommendation in the East of England Clinical Senate report (Review of Accident and Emergency Services at Grantham and District Hospital – report of the Independent Clinical review panel – 22 November 2017) be recorded, on the basis that acceptance of the first recommendation would prejudice any future consultation on A & E Services at Grantham and District Hospital and the current restricted opening hours would in effect be made permanent; and the consultation exercise would be based on these opening hours as the status quo, rather than the previous 24/7 service.

3.    That the Board of United Lincolnshire Hospitals NHS Trust be requested to defer its planned decision on 15 December 2017 in relation to the East of England Clinical Senate report to its next meeting on 26 January 2018, as this would enable the Health Scrutiny Committee to give detailed consideration to the Clinical Senate's report and recommendations at its next Committee meeting on 17 January 2018.

4.    That representatives from NHS Improvement, United Lincolnshire Hospitals NHS Trust, the Clinical Commissioning Group and the East of England Clinical Senate be invited to the next meeting of the Committee scheduled for the 17 January 2018.