Agenda item

(To receive a report from Simon Evans (Health Scrutiny Officer) providing detail of a public consultation, in relation to decommissioning congenital heart disease surgery from the East Midlands Congenital Heart Centre (formerly known as Glenfield Hospital. Will Huxter (Regional Director of Specialised Commissioning (London), NHS England) and Dr Geraldine Linehan (Regional Director of Specialised Commissioning (Midlands and East), NHS England) will be in attendance for this item)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer) which provided details of a public consultation relating to decommissioning of congenital heart disease surgery from the East Midlands Congenital Heart Centre (formerly known as Glenfield Hospital).

Will Huxter (Regional Director of Specialised Commissioning (London)) and Dr Geraldine Linehan (Regional Clinical Director of Specialised Commissioning (Midlands and East) of NHS England were in attendance for this item.

On 21 July 2016 the Committee unanimously concluded that to decommission Level 1 Paediatric Cardiac and Adult Congenital Heart Disease Services from the East Midlands Congenital Heart Centre would constitute a substantial variation.  It also agreed that the Chairman would write to NHS England to outline the views of the Committee and to seek commitment to a full consultation.

Correspondence between the Chairman and NHS England had established or confirmed the following:-

·       No final decision had been taken in regard to the future of University Hospitals of Leicester NHS Trust or any of the other congenital heart disease services in England;

·       Information regarding consultation about the proposals would be communicated as widely as possible, well in advance of any consultation and NHS England would ensure that the consultation took account of those services which could be impacted by any change to CHD services, including paediatric intensive care and ECMO;

·       NHS England confirmed that they were now in the pre-consultation engagement stage;

·       The national and regional panel assessments of Congenital Heart Disease (CHD) centres against key standards in the new service specification, which came in to effect on 1 April 2016 were completed in June 2016.  Following these assessments, the Committee of NHS England agreed with the recommendation that centres assessed as 'not satisfactory and highly unlikely to meet service standards' should be served notice that NHS England was minded to cease to contract their services.  Providers had been informed of these assessments at the end of June 2016 and advised that any necessary public involvement undertaken before services changes were implemented.

Individual assessment reports for 21 hospital trusts were published by NHS England on 13 September 2016 and were available at the following link:-

          www.england.nhs.uk/commissioning/spec-services/npc-crg/chd/#reports

It was reported that NHS England had met with staff, patients and stakeholders of University Hospitals of Leicester NHS Trust to discuss the assessment of the Trust against the standards.  Additionally, NHS England advised that extensive correspondence and discussions had taken place since that visit.

Blogs by Will Huxter had also been published on the NHS England website, the most recent of which, on 23 November 2016, indicated that consultation would not begin until early in 2017.

The Committee was advised that NHS England had made no final decision, that the proposal did not include closure of all services at University Hospitals of Leicester NHS Trust (UHL) and that some would remain.  Information had been sought from the Trust about the impact of the proposals on all services including any financial implications.

In addition to work being carried out in relation to Congenital Heart Disease Services, a national piece of work was ongoing to look at paediatric and intensive care which would also be relevant to these proposals.

Additional capacity in all centres was also being considered and, despite the level of detail contained within the report, it was reported that the key challenge had been in relation to the level of surgical activity.  It was suggested that surgeons at UHL had not met the minimum standard of 125 operations per surgeon (375 operations per year due to the requirement for three surgeons per operation) and that the Trust had also not provided any proposal to deliver this or the target expected by 2021.

It was acknowledged that patients accessed a range of services and it was proposed to have a specialist medical centre at Glenfield Hospital to provide care to a number of patients who did not require surgery or specialist care.

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

·       It was reported that two providers in the country had not met the standard of 375 operations per year – Leicester and Manchester;

·       NHS England needed to be confident that all services and providers would be able to meet all standards set although, as stated within the report presented, none of the current providers met every standard;

·       UHL had provided a growth plan to NHS England which illustrated how the 2021 standard would be met by surgeons and included increasing the surgeons from three to four.  The Committee asked what had been included in growth plans for other centres and was advised that other centres had not been required to produce a growth plan as they already met the surgical standard;

·       It was reiterated that there was no financial motivation to spend less on Congenital Heart Disease services nationally  and that all current providers, including UHL, had been asked for details of any financial impact that these proposals would have on their organisations;

·       The Committee was extremely concerned that the lack of this type of centre within the East Midlands would be to the detriment of residents in the East Midlands and Lincolnshire in particular.  The lack of a centre would result in high costs to families and, potentially, parents being unable to travel with their children to a centre so far away.   Lincolnshire, simply, had no public transport, especially from the east coast of the county and families on low incomes generally had no car, were unable to afford taxi fares or bus/train fares to travel that great distance; 

·       It was acknowledged that other rural areas faced similar challenges, however NHS England was urged to undertake a quality impact assessment for the people of Lincolnshire and the East Midlands before making their final decision;

·       The Committee asked why patients were being transferred to UHL when Birmingham was unable to cope with the pressure.  It was suggested that the system was stretched overall but that specific issues could not be addressed.  The benefit of larger centres was being considered to address capacity issues but the Committee remained unconvinced and requested that information be provided on why UHL was taking the additional patients from Birmingham;

·       NHS England had adopted a standard that required a team of four surgeons, which would provide improved safety and outcomes for patients.  Some surgeons were already undertaking over 200 procedures per annum, and it was thought sensible to have four surgeons at each unit undertaking a minimum of 125 procedures to enable improved outcomes and safety, as well as being able to manage the number of cases;

·       The standards had been set at that level following a great deal of effort, consultation and agreement with a number of people to improve those standards.  The Committee asked for details of the experts who sat on the panel to decide on this standard following the consultation exercise in 2014;

·       The view of Healthwatch was that they accepted the standards from NHS England on the grounds of patient safety which was the overriding and essential issue, especially if the service was enhanced by having four surgeons instead of operating a 1 in 3 rota.  However, Healthwatch was concerned that a decision may be made which NHS England may regret should the required standards be met and staff appointed at UHL in the next few years;

·       Healthwatch also held the view that such great emphasis should not be put on travel distance as it was thought that people would travel any distance within the UK to ensure the right care for their child;

·       It was confirmed that the standard set for surgical procedures of this type were counted when undertaken by surgeons in either an NHS or a private role as it was acknowledged that some surgeons did undertake private work in addition to NHS duties.  The Committee requested the split between private and NHS surgical procedures for each surgeon.  NHS England explained that individual surgical data was held by the provider but that this would be sourced and provided to the Health Scrutiny Officer;

·       The standards were nationally defined and set taking in to account the number of surgeons required to operate on a child's heart.  The numbers were counted by a national database run by NICOR [National Institute for Cardiovascular Outcomes Research] which was considered to be the most equitable way of doing so;

·       The Committee asked whether consideration had been given to setting a limit for patients travelling to access services, as it was suggested that the distance between parts of Lincolnshire and Birmingham was to o long for many Lincolnshire residents;

·       It was asked if the input of social services in hospitals had been given any consideration following Birmingham Children's Services Department being put in special measures.  The Committee was concerned that Lincolnshire children may become subject to care from that particular department as a result of receiving clinical care in Birmingham.  NHS England advised that they were unsure if this had been considered, but would provide that information to the Health Scrutiny Officer;

·       The Chairman requested that NHS England consider holding two or three public meetings in Lincolnshire for parents and other interested parties to attend.  These should be held in East, South and Central Lincolnshire.

The Chairman invited colleagues from NHS England to come back to continue discussions on this item at the Committee's meeting scheduled for Wednesday 18 January 2017 and was keen that these discussions took place prior to the commencement of Purdah.

RESOLVED

1.    That the report and contents be noted; and

2.    That NHS England be requested to attend the meeting of the Health Scrutiny Committee for Lincolnshire on Wednesday 18 January 2017.

At 11.55am, the Committee was adjourned for a ten minute comfort break.

At 12.05pm, the Committee reconvened.