Agenda item

(To receive a report by Jan Sobieraj (Chief Executive – United Lincolnshire Hospitals NHS Trust (ULHT)) which provides the Committee with details of the decision made on 2 November 2016, by the Trust Board of United Lincolnshire Hospitals NHS Trust, for the closure of the A&E Department to continue for at least a further three months.  Jan Sobieraj (Chief Executive – ULHT) and Dr Suneil Kapadia (Medical Director – ULHT) will be in attendance for this item)

The Chairman reported the findings of research undertaken prior to the meeting in order to assist the Committee with their consideration of this item:-

·       In 2007, Lincolnshire Primary Care Trust (PCT) held a consultation entitled Shaping Health for Lincolnshire, which included a proposal for a network of two major A&E Departments (Lincoln County and Pilgrim Hospitals) which were to be supported by other A&E Departments and minor injury units.  This proposal was opposed by the Health Scrutiny Committee for Lincolnshire but supported by 88% of respondents to the consultation.  Lincolnshire PCT adopted the proposal in November 2007. It was understood that the main effect was the restriction of stroke admissions at Grantham;

·       A subsequent consultation in 2013 entitled Shaping Health for Mid Kesteven included a commitment to Grantham A&E, but did not put any further restrictions on the types of patients, which may be received at Grantham A&E, other than putting a GP into Grantham A&E, and linking the A&E with the out-of-hours service; and

·       It was understood that patients who required emergency surgery and certain paediatric emergencies had not been treated at Grantham A&E since at least 2002.  One of the key issues to be addressed was the definition of a Level 1 A&E and the difference between a Level 1 and a minor injuries unit.

 

The Chairman made a statement reminding all present that the purpose of the Committee was to scrutinise NHS Healthcare; and the Health and Wellbeing Board and their services and outcomes and not for the Committee to criticise individuals to stray in to matters which were the proper remit of other organisations, such as employment issues.

 

In accordance with the County Council's Constitution, the following local Councillors expressed their wish to speak:-

 

·       Councillor D C Morgan (Grantham South);

·       Councillor R Wootten (Grantham North);

·       Councillor R G Davies (Grantham North West); and

·       Councillor L Wootten (Grantham East).

 

A request was made to the Chairman, by Councillor R G Davies, to allow a spokesperson from the "Fighting 4 Grantham Hospital" campaign group to address the Committee also.  The Chairman granted the request and invited Melissa Darcey to join the meeting.

 

Following the accepted convention, local members and the member of the public would be allowed to speak for up to three minutes.

 

The Chairman then invited Councillor D C Morgan to address the Committee, during which the following points were noted:-

·       In addition to her role as a local member for Grantham, Councillor Morgan confirmed that she was also the Chair of SOS Grantham Hospital and, in total, represented approximately 6000 residents in Grantham town centre area;

·       Immediate reinstatement of 24/7 services at Grantham A&E Department was sought;

·       A request was made that the Committee scrutinise the reasons given by United Lincolnshire Hospitals NHS Trust to close Grantham A&E Department overnight;

·       A review in to the information submitted to NHS Improvement for approval of this temporary closure was requested; and

·       In relation to the impact of the closure, research undertaken by SOS Grantham Hospital found that the closure posed a higher risk to more people in the local area than suggested by the assessment information provided by ULHT.

 

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

·       Councillor Wootten advised the Committee that he addressed the Committee on behalf of himself, Councillor M A Whittington (Grantham Barrowby), Councillor B Adams (Colsterworth Rural) and Councillor M J Hill (Folkingham Rural);

·       Two public rallies had taken place in protest at the closure and 41,000 people had signed a petition to support its re-opening;

·       30,000 Grantham residents were seen at Grantham A&E last year, 5,000 of which were admitted for further treatment;

·       The Trust were urged to retain services as ambulances were already waiting longer than expected;

·       The people of Grantham were being expected to travel up to 30 miles to access the nearest A&E;

·       GP appointments could take up to four weeks so it was unsurprising that A&E attendance had increased;

·       A document had indicated that there were no plans to downgrade the services at Grantham A&E and Councillor Wootten asked why this had changed;

·       Having attended the ULHT Board meeting in Boston on 1 November 2016, it had been disappointing to find that the closure would be extended to February 2017 without any public consultation; and

·       The Committee was requested to do all that was necessary to rectify the situation.

 

Councillor R G Davies was invited to address the Committee, during which the following points were noted:-

·       The personal impact on residents and families of Grantham, in particular those with children, was highlighted; and

·       It was suggested that a number of untruths had been shared with residents on numerous occasions which had resulted in the perception that these were, in fact, truths.

 

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

·       As the largest town in Lincolnshire with continuous growth, many industrial estates and the A1 corridor and the East Coast Mainline running through it, it was felt that services in Grantham A&E should be extended rather than reduced or withdrawn;

·       Grantham had areas of deprivation, as did many parts of the county, and the Committee was asked to consider why residents should travel to other A&E departments at their own, great, expense;

·       It was noted that Neighbourhood Teams were still unavailable which further impacted on healthcare provision for these residents; and

·       The Committee was urged to give their understanding, compassion and support in reinstating these services to Grantham.

 

Melissa Darcey was invited to address the Committee, during which the following points were noted:-

·       A Facebook page had been set up by the campaigners which had become a source of support to the community over the last two months.  It was reported that residents had been contacting them worried, scared and unable to access emergency care at all hours of the night;

·       Having attended the ULHT Board meeting in Boston, in November, the group had been disappointed with the perceived lack of consideration given to the issues faced by Grantham residents resulting in the overnight closure being extended; and

·       A plea was issued to ULHT to realise the actual impact on real people of their actions.  ULHT were also requested not to label the campaigners as 'scaremongers' and to consider the 'real' concern for the people of Grantham.

 

A report by Jan Sobieraj (Chief Executive – United Lincolnshire Hospitals NHS Trust (ULHT)) was then considered which provided details of the decision made on 2 November 2016, by the Trust Board of ULHT, for the partial closure of the A&E Department at Grantham and District Hospital to continue for a further three months, at least.

 

Jan Sobieraj (Chief Executive – United Lincolnshire Hospitals NHS Trust (ULHT)) and Dr Suneil Kapadia (Medical Director – United Lincolnshire Hospitals NHS Trust (ULHT)) were in attendance for this item.

 

It was stressed that the decision to close Grantham A&E Department between 6.30pm and 9.00am had been taken by the ULHT Board.  The role of NHS Improvement was to ensure that the correct procedures had been followed in making the decision but not to confirm the decision itself.

 

The Committee was advised that the reduction in opening hours at Grantham and District Hospital had enabled the A&E Department at Lincoln County Hospital to be supported up to an additional 85 hours per week by middle grade and consultant staff from the A&E Department at Grantham and District Hospital.

 

It was reiterated to the Committee that all options had been considered with an aim to deliver a safe service for all three Emergency Departments at ULHT.  The provision of these emergency services, particularly at Lincoln County Hospital, remained fragile and, on the grounds of patient safety, required the continued support of A&E medical staff from Grantham and District Hospital.

 

A threshold of 21wte (whole time equivalent) middle grade doctors had been set as the minimum level required to safely staff all three A&E Departments (Lincoln, Pilgrim and Grantham) when the decision was made to reduce the opening hours of Grantham A&E Department.  The report demonstrated that the recruitment drive had identified the potential to reach this threshold but not until February 2017 and further anticipated that a further period of induction to enable new recruits to become fully operational would be required.

 

The ULHT Trust Board had considered the following four options for the A&E Department at Grantham and District Hospital:-

1.    To reinstate a 24 hour Accident & Emergency Department at Grantham and District Hospital;

2.    To keep the current opening hours of 0900-1830;

3.    To extend the opening hours beyond its current position;

4.    To reduce the opening hours from its current position.

 

Since the report was published, the Committee was provided with the following points to note:-

·       Although the temporary closure was regrettable, ULHT urged the Committee not to confuse the expected content of the Sustainability and Transformation Plan (STP) and Lincolnshire Health and Care (LHAC) document with the action taken in this case;

·       Lincoln County had received applications from ten middle grade/consultant candidates, of whom four had been offered positions.  The successful candidates would be required to undergo an English exam, receive validation from the General Medical Council (GMC) and produce the necessary visas.  This process meant that the earliest these posts would be filled would be January/February 2017;

·       Concerns raised about children being in the department after 9pm when the last shift ended had been addressed.  This had now been extended to 10pm and procedure implemented where a consultant would remain with the child until transfer to another facility was undertaken; and

·       Page 48 of the agenda pack suggested that Lincolnshire Police had used 78 hours of police hours on eight occasions where they would have normally used Grantham.  This statement had been made by Lincolnshire Police and ULHT was seeking further information on the breakdown of those hours.

 

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

·       A list of services not provided by Grantham A&E Department during normal opening hours included multiple trauma, cardiac conditions, strokes, GI bleeds, acute surgical emergencies, maternity and paediatrics (although children would be seen, GPs were advised not to refer to an A&E Department routinely).  The exclusion protocol had been included within the agenda pack and could be found on page 53;

·       It was reiterated that ULHT had not taken this decision lightly and agreed that it was not an ideal solution.  However, it was deemed to be the least worst option when the presenting factors were considered in July and August 2016 and accepted that some patients would have had a poor experience as a result;

·       Some members understood the frustrations of residents in the Grantham area but also recognised the issue of patient safety and the risk involved in keeping a department open without the minimum level of doctors;

·       The appointment of doctors was a complex issue due to the many factors involved throughout the application and appointment process.  Assurance could not be given that doctors would be in post in January and February 2017 but that the Trust continued with their endeavours to do so;

·       The report of the Royal College of Physicians (RCP) in September 2016 indicated that recruitment difficulty was a national issue and one which meant that the market was extremely competitive, giving doctors choice in positions available.  Despite the financial pressures faced by ULHT, money was being spent in all areas of recruitment to increase the number of doctors available in order to reopen Grantham A&E;

·       It was stated that the intention was to reopen Grantham A&E and that all efforts would be made to reach that goal.  It was clarified that the status quo prior to 16 August 16 would be implemented once the department was reopened;

·       All relevant organisations had been made aware of the situation posed across all three A&E Departments which resulted in the action taken.  It was stressed that the only reason the hours of the department had been temporarily reduced was due to the lack of qualified staff to sufficiently cover all three departments;

·       There had been a shift in services over the last 20 years and therefore it was inappropriate to react to the public demand to reinstate services which had not been in place since 2010 or, in some cases, 2002;

·       A shortage of nurses, therapists and medical staff was prevalent across the NHS as a whole and the challenge continued to encourage people to choose a career in the NHS as they would contribute to the community whilst developing as an individual;

·       It was suggested that the number of junior medical staff (trainees) moving in to secondary care (hospitals) was likely to decrease further and the intent was to alter training to give greater emphasis to the community;

·       Although recruitment remained a key issue, it was reported that the retention rates for the Trust were good although could be improved.  A Lincolnshire-wide strategy was being developed to attract and encourage more people to live and work in Lincolnshire.

 

RESOLVED

1.    That the closure of Accident and Emergency Services between 6.30pm and 9.00am at Grantham and District Hospital be deemed a substantial variation in the provision of health services in the Grantham and surrounding area, for the purposes of Regulation 23(1) of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013;

2.    That it be recorded that the Health Scrutiny Committee for Lincolnshire was not reassured that Accident and Emergency Services would be reinstated at Grantham and District Hospital between 6.30pm and 9.00am by February 2017; and that as a result the Committee concluded that the closure of the Accident and Emergency Services between these times was, in effect, permanent; and

3.    That a referral be made to the Secretary of State for Health in accordance with Regulation 23(9)(c) of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, on the basis that the closure of Accident and Emergency Services at Grantham and District Hospital between 6.30pm and 9.00am was not in the interests of health service provision in the Grantham and surrounding area.