Agenda item

(To consider a report by Simon Evans (Health Scrutiny Officer) which provides the Committee with some points of clarification from University Hospitals of Leicester NHS Trust, including a letter from the Trust's Chief Executive, following the last meeting.  Representatives from University Hospitals of Leicester NHS Trust will be in attendance)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer) which provided some points of clarification to the Committee from University Hospitals of Leicester NHS Trust, including a letter from the Trust's Chief Executive, following the last meeting.

Dr Frances Bu'Lock (Honorary Associate Professor in Congenital and Paediatric Cardiology – East Midlands Congenital Heart Centre) and Jon Currington (Head of Partnerships, University Hospitals of Leicester NHS Trust) were in attendance for this item.

On 21 December 2016, Will Huxter (Regional Director of Specialised Commissioning, NHS England (London Region)) and Dr Geraldine Linehan (Regional Clinical Director of Specialised Commissioning, NHS England (Midlands and East Region)) attended the Committee to provide information on NHS England's reasoning for indicating that the East Midlands Congenital Heart Centre (EMCHC) would not meet the required standards for congenital heart disease surgery with a view to decommissioning those services from the EMCHC.

Both Mr Huxter and Dr Linehan were requested to attend this meeting to provide additional information and further points of clarification requested by the Committee.  However, they had indicated that they would be unable to attend in person but would provide the information in writing.  The information had been received and circulated to the Committee prior to the meeting.

The view of University Hospitals of Leicester NHS Trust had been included within the report by way of a letter dated 1 January 2017 from John Adler (Chief Executive) to the Chairman.  The Chairman had also written to NHS England to request dates for the formal public consultation and it was noted that the response from Mr Huxter confirmed that permission had been granted by the Department of Health to run the consultation during Purdah. 

Dr Bu'Lock addressed the Committee and noted the following responses to the statements made by NHS England at the last meeting:-

·       Point 1 (a) – 375 cases this year – this was not a requirement of the new cardiac review standards – the actual standard stated 375 cases were required, averaged over three years from April 2016.  East Midlands Congenital Heart Centre would achieve this standard in the required timescales;

·       Point 1 (b) – 500 cases by 2020 – a growth plan had been provided to NHS England on 7 November 2016 which showed that East Midlands Congenital Heart Centre would achieve the required 500 cases by 2020;

·       Point 1 (c) – surgeons – the standards did not require surgeons to be employed in a substantive role and other centres also had consultants on locum contracts.  It was usual practice to offer locum contracts to allow overseas consultants time to register with the GMC specialist register (a pre-requisite for a substantive post). On 2 December 2016 an appointment for a new substantive consultant was made as well as an additional appointment from those interviews to allow service development and succession planning.  Despite the adverse climate, there were nine high quality applicants for this particular post;

·       Point 2 (a) – network and out of area referral were purely patient choice – there was a network development plan which would increase, not decrease, choice for patients.  The growth plan assumed that patients in close proximity to the centre would be offered the choice of Leicester but did not assume that every patient would choose EMCHC.  NHS England's plans would substantially reduce local patient choice;

·       Point 2 (b) – comments that patients wanted to experience care from someone with the best clinical expertise – whilst correct, the surgeons at EMCHC had over fifty year's combined experience in congenital cardiac surgery.  The outcome of that surgery, however, was of greater relevance; the surgical outcomes at Glenfield Hospital exceeded expectations in respect to deaths within 30 days following cardiac surgery;

·       Point 3 – only UHL and Manchester did not meet the 375 standard – the NICOR data for 2015/16 on the NICOR website showed that last year Alder Hey did 348 surgical cases, Newcastle did 328  and EMCHC did 326;

·       Point 4 – NHS England had no plans to close EMCHC, there would continue to be specialist medical services for CHD at Glenfield – on 7 November 2015, UHL submitted an impact assessment of what services would not be able to be provided if Level 1 commissioning was removed and this included all invasive interventions and surgery;

·       Point 5 – Transition – extra capacity would be required elsewhere and that Birmingham and had submitted funded plans to achieve this.  Transition would take time 1-2 years to complete – the current capital availability within the NHS was very limited and it was confirmed at the last Cardiac Clinical Reference Group meeting that there was no planned independent verification of how the additional capacity was going to be funded or provided;

Work also continued to increase the flow in to Leicester and to provide patients with all choices available to them locally. 

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

·       Despite the comments from NHS England that emergencies for this type of care was rare when referring to transportation in rural areas, it was noted that only 70% of surgery was planned and the remaining 30% was emergency or salvaged cases.  It was further explained that antenatal diagnosis would prevent babies being born elsewhere without unexpected complications but the travel issue was still applicable regardless of the circumstances;

·       Although Glenfield had not reached 375 operations in the past which was the main issue raised by NHS England in relation to quality, the mortality rate at EMCHC was 0.6%.  UHL would continue to challenge the statement and interpretation of NHS England that 500 operations give better quality of care;

·       The Committee was asked to note that there were 400 standards to be met and the standard relating to the number of procedures carried out per surgeon was only one of these, if the standards were applied equitably, all centres would be closed;

·       The figures provided from NHS England were historical and it was reported that the figures for 2015/16 were available but had not yet been validated.  It was also confirmed that the figures for 2016/17 would be available by the end of March 2017 but, again, would not be validated;

·       NHS England also reported that a Growth Plan had not been received from EMCHC.  It was stressed that this had been submitted to NHS England;

·       A comparison was made between the work of Great Ormond Street Hospitals and EMCHC.  It was explained that Great Ormond Street had become a 'brand' with a huge fundraising profile attached to it and although EMCHC also provided a specialised service     the resources were not available to undertake a similar level of promotion;

·       It was acknowledged that finance played a part in the review of these services, however, closing a centre would stop surgeons being able to do any surgery in their specialised field which would, in turn, result in surgeons leaving that hospital to find work elsewhere before the closure actually took place.  This would leave existing patients at risk;

·       UHL was to present to the All Party Parliamentary Group on Heart Disease and would report the outcome to the Committee;

·       In relation to Extra Corporeal Membrane Oxygenation (ECMO) machines, NHS England indicated that all nine centres offer ECMO services to patients.  It was reported that only EMCHC was commissioned to undertake respiratory ECMO and patients who required monitoring of this type on a long term basis would be referred to EMCHC at Glenfield;

·       The Committee was asked to note that all centres were required to do a self-assessment but that NHS England had not revisited that requirement;

·       Implementation Groups had been set up by NHS England some months in advance, however it was reported that the meetings scheduled for 18 January 2017 and March 2017 had both been cancelled.

RESOLVED

1.    That the information received from NHS England, in relation to the questions raised by the Health Scrutiny Committee on 21 December 2016 and circulated on 17 January 2017, be noted;

2.    That the information submitted within the letter from John Adler (Chief Executive, University Hospitals of Leicester NHS Trust) dated 1 January 2017 be noted;

3.    That a submission to NHS England in advance of the formal consultation be drafted by the Health Scrutiny Officer, including the disappointment of the Committee that the Department of Health had chosen to ignore Purdah, prior to 15 February 2017 be supported; and

4.    That the information provided by NHS England, circulated to the Committee on 17 January 2017, be sent to John Adler (Chief Executive, University Hospitals of Leicester NHS Trust) with a request to provide a formal response to the content which could be included within the pre-consultation submission to NHS England, be agreed.