Agenda item

(On 8 July 2016, NHS England announced that "subject to consultation with relevant trusts and, if appropriate the wider public" it was decommissioning congenital heart disease surgery ("Level 1 services") from the East Midlands Congenital Heart Centre (formerly known as Glenfield Hospital).  This report seeks the Committee's view on the next step) 

A report by Richard Wills, the Director responsible for Democratic Services, was considered by the Committee which provided information following the announcement, on 8 July 2016 by NHS England, that "subject to consultation with relevant Trusts and, if appropriate, the wider public", congenital heart disease surgery (Level 1 services) would be decommissioned from the East Midlands Congenital Heart Centre (formerly known as Glenfield Hospital).

The Chairman introduced the report which provided the historical background of the reviews undertaken of this service over the last eight years including two full public consultations, the most recent of which was held in September 2013.  This review listed the following aims:-

·       Securing the best outcomes for all patients;

·       Tackling variation; and

·       Improving patient experience.

The review also referred to three levels of service:-

·       Level 1 – Specialist Surgical Centres;

·       Level 2 – Specialist Cardiology Centres; and

·       Level 3 – Local Cardiology Centre

In response to the consultation, on 14 December 2014, the Health Scrutiny Committee for Lincolnshire had provided three particular issues for consideration:-

·       The number of surgeons at each centre – whether a one-in-three or a one-in-four was appropriate;

·       The minimum number of operations undertaken by each surgeon each year, with 125 operations proposed in the consultation averaged over a three year period; and

·       The co-location of congenital heart services with other paediatric services, which would mean Glenfield Hospital having to move its heart surgery services from Glenfield Hospital to Leicester Royal Infirmary.

The NHS England Board received the report from the review on 23 July 2015, where approximately two hundred new standards and service specifications were approved, which providers were expected to meet from April 2016, with a five-year trajectory to full compliance.  The following excerpt was taken from the announcement issued by NHS England on 8 July 2016, pertinent to the University Hospitals of Leicester NHS Trust:-

          "Subject to consultation with relevant Trusts and, if appropriate, the wider public, NHS England will also work with University Hospitals of Leicester NHS Trust and Royal Brompton & Harefield NHS Foundation Trust to safely transfer CHD surgical and interventional cardiology services to appropriate alternative hospitals.  Neither University Hospitals Leicester or the Royal Brompton Trusts meet the standards and are extremely unlikely to be able to do so.  Specialist medical services may be retained in Leicester."

Prior to this statement, NHS England had written to the Chief Executive of University Hospitals of Leicester NHS Trust advising that the East Midlands Congenital Heart Centre did not meet all the April 2016 requirements and was unlikely to do so.  As a result, NHS England were minded to cease commissioning of Level 1 (Specialist Surgical Services - congenital heart disease) from the Trust.  The Trust responded to NHS England on 5 July 2016, setting out the excellent progress made during the previous 18 months.

The Chairman further explained that there had been some developments since the agenda pack had been published and asked the Committee to note the following:-

·       On 15 July 2016, NHS England published a series of documents on its website including the commissioning standards and specifications.  A key document for consideration was entitled "Paediatric Cardiac and Adult Congenital Heart Disease Standards Compliance Assessment:  Report of the National Panel" which provided NHS England's assessment of all surgical centres, including services provided at Leicester;

·       In the "What Happens Next?" section of the document, it stated that "The Specialised Services Commissioning Committee has determined that subject to appropriate public involvement and/or consultation, a change in service provision is appropriate and we expect that any such changes will be of a managed process and that continuity of care for patients will be a high priority" however it remained unclear whether there would be a full public consultation;

·       A number of examples were provided of those who had formally recorded their opposition to the proposals.  These included the Chairman of the Leicester City Council Health and Wellbeing Board; the East Midlands Congenital Heart Centre Stakeholder Meeting; East Midlands Councils; and the Cabinet of Leicestershire County Council who requested that the Leicestershire Health Overview and Scrutiny Committee give consideration to the matter.

The Chairman went on to explain that whilst NHS England might argue that there had been a previous consultation in 2014, this consultation was limited to the standards and specifications and did not excuse NHS England from full consultation on the application of those standards and specifications to particular centres.  Furthermore, Health Overview and Scrutiny Committees were in a unique position of having powers under the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 including the ability to make a referral to the Secretary of State.

The amended actions were circulated to the Committee.

Members were given the opportunity to ask questions, during which the following points were noted:-

·       It was reported that Leicestershire MPs had met with the Secretary of State to raise their concerns and that no MPs from Lincolnshire had attended.  It was further noted that Parliament was now in Recess until September which would, potentially, be too late to act if waited until it reconvened;

·       It was confirmed that local mediation was required before the Committee was able to approach the Secretary of State directly;

·       The Committee was concerned about the additional expenditure for parents in attending the proposed centre in Birmingham and the impact on siblings;

·       It was asked how this closure would affect Level 2 and Level 3 services and an additional concern raised that this may increase severity of illnesses and mortality due to the inability of parents to travel such distances for treatment;

·       Dr B Wookey clarified the position of Healthwatch Lincolnshire and advised that the actions proposed for the Committee's approval were fully supported;

·       Dr Wookey expressed disappointment that the views of Healthwatch Lincolnshire in relation to supporting the one-in-four rota for consultant surgeons had not been incorporated within the response of the Committee, at Appendix A of the report, found on page 18.  Healthwatch Lincolnshire were also concerned that the report did not indicate when this position would be met or why it had not yet been met;

At this point of the proceedings, Councillor Mrs L A Rollings asked the Committee to note that her daughter was employed as a Junior Doctor at Birmingham.

At 10.45am, Councillor Mrs R Kaberry-Brown joined the meeting.

·       It was confirmed that should NHS England respond advising that the proposals were not a substantial variation, it would be for the Committee to prove otherwise to therefore enforce a full consultation;

·       An e-petition had been started by parents who had, or were using, the East Midlands Congenital Heart Centre and this had received over 20,000 signatures.  This could be found at https://www.change.org/p/jeremy-hunt-mp-save-the-east-midlands-congenital-heart-centre-at-the-glenfield-hospital;

RESOLVED

1.    That the view to decommission Level 1 Paediatric Cardiac and Adult Congenital Heart Disease Surgery Services from the East Midlands Congenital Heart Centre constituted a substantial variation, as defined by Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, which imposed on NHS England a duty to consult as the responsible commissioner of congenital heart disease services, be unanimously agreed;

2.    That the request to authorise the Chairman to write to NHS England outlining the Committee's resolution in (1) above, seeking NHS England's commitment to full public consultation, be unanimously agreed;

3.    That, in the event that NHS England decline to undertake consultation, the invoking of the procedures set out in Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, including the initiation of discussions with NHS England, be unanimously agreed; and

4.    That delegation to the Chairman, should a simultaneous response be required, be unanimously agreed.