Agenda item

(To receive a report by Simon Evans (Health Scrutiny Officer) which provides information on a consultation of Congenital Heart Disease Services for children and adults launched by NHS England on 9 February 2017.  Will Huxter (Regional Director of Specialised Commissioning (London), NHS England) and Dr Geraldine Linehan (Regional Clinical 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 information on a consultation of Congenital Heart Disease Services for children and adults launched by NHS England on 9 February 2017. 

Will Huxter (Regional Director of Specialised Commissioning (London)) and Dr Geraldine Linehan (Regional Clinical Director of Specialised Commissioning (Midlands and East)) were in attendance to present information on the consultation content and process.

Background of the consultation was provided for the Committee.  On 9 February 2017, NHS England launched its consultation on Congenital Heart Disease Services for children and adults.  Six documents had been published on the NHS England website as part of the consultation process and could be found on the NHS England website (www.engage.england.nhs.uk/consultation/chd).

The proposals for consultation were outlined within the consultation summary document which included the following statement:-

          "Surgery and interventional cardiology for children and adults would cease at University Hospitals of Leicester NHS Trust, and patients requiring such procedures would be most likely to receive their care at either Birmingham Children's Hospital NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust or Leeds Teaching Hospitals NHS Trust, as closer for some patients than Birmingham.  There is a possibility that the hospital trust might continue to provide CHD services for children and adults other than surgery and interventional cardiology.  This option remains open for discussion"

In relation to patients in Lincolnshire, NHS England suggested by reference to maps in Congenital Heart Disease Equality and Health Inequalities Analysis – Draft for Consultation that most Lincolnshire patients would be expected to be treated in Leeds General Infirmary.

A list of initial consultation events was published on 9 February 2017 and included an event on Monday 8 May 2017 4.00pm – 6.00pm.  It was confirmed that this event would take place in the lecture theatre at Lincoln County Hospital.  Unlike other events, this event would not be ticketed.

Other events listed by NHS England included meetings of health overview and scrutiny committees. As a result of the meetings held in the East Midlands, consideration would be given to the consultation by seven of the nine upper tier authorities in the East Midlands.

On 24 January 2017 the Chairman wrote to the Secretary of State for Health to raise concerns that NHS England had indicated that they had received clearance for the consultation period to run through the local government purdah period.  Philip Dunne MP, the Minister of State for Health replied on 21 February 2017 to advise that NHS England had consulted the Cabinet Office regarding this and had acted on it by extending the consultation to 5 June 2017.

Mr Huxter thanked the Committee for the opportunity to address the Committee again now that the consultation had been launched.  It was confirmed that the proposals for discussion related to a national consultation on Congenital Heart Disease Services which included events and discussion at a local level. 

It was emphasised that the consultation was on proposals by NHS England for these services and not decisions.  The Board of NHS England intended to make the decision in public following consideration of all consultation responses. 

NHS England reported that helpful discussions had been held with University Hospitals of Leicester NHS Trust in addition to work being undertaken on paediatric colocation where it was found that the key outstanding difference to provide a Level 1 service was the level of activity by a surgeon.  NHS England continued to explain that the Trusts own figures stated 350 for 2016/17, 25 below the minimum standard. 

It was reported that approximately 500 patients with Congenital Heart Disease in the East Midlands may require surgery and that most children from Lincolnshire currently attend Glenfield Hospital with only six out of ten adults attending UHL for surgery.  Patient choice was emphasised, and it was not NHS England's role to direct patients to particular Level 1 centres.  The proposal in the consultation was to seek ways in which the standards could be implemented and the proposal pertinent to UHL was based on the standards not being met, therefore removing Level 1 services but to continue with a Level 2 service.

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

·       When asked if all the centres who provided Level 1 services involved in the consultation were required to meet all standards in full, it was explained that a different approach had been taken with Newcastle.  This was due to Newcastle being only one of two paediatric centres which were able to undertake heart transplants, therefore NHS England had given them a longer period of time in which to meet the standards.  NHS England welcomed the views of the Committee in relation to the proposal to deal with Newcastle differently to the other centres;

·       A letter had been received by the Chairman, from Michael Wilson (CHD Programme Director, NHS England) on behalf of Will Huxter, which indicated that it was expected that the Board would reach a decision later in the year but that the timetable for post-consultation analysis and decision-making was still under development.  The Committee indicated disappointment that a date had not yet been set.  Dismay was also expressed that the Cabinet Office had granted NHS England permission to run this consultation through a local government purdah period.  When pressed, Mr Huxter explained that the endpoint timetable would be partly influenced by the volume of responses and the length of time required to undertake the analysis.  A commitment was made by Mr Huxter that a clear timetable for the outcome and decision following the consultation would be provided to the Committee prior to the commencement of Purdah;

At 10.40am, Councillor Mrs R Kaberry-Brown entered the meeting.

·       The proposal for University Hospitals of Leicester NHS Trust, within the main consultation document, included reference to Oxford and the cessation of CHD surgery in 2010 following the deaths of a number of babies (paragraphs 39 and 40).  A sentence at the end of paragraph 40 stated "we do not use the Oxford illustration in any way to detract from the concerns that you might have about our proposals but it does demonstrate that change such as this can take place with minimal impact".  Despite this, the Committee were dismayed that the issues at Oxford were being likened to those at Glenfield Hospital.  Mr Huxter indicated that there had been no intention to imply that there were any problems with the quality of care at Glenfield, only that the transfer of surgical services from one provider to another could be done successfully with little disruption;

·       The Committee noted the extraordinarily good mortality rate at Glenfield and, although the standards not being completely met at this time, an excellent service continued to be provided overall;

·       The rurality of Lincolnshire and the ability to travel to Leicester via public transport was raised as a serious concern by the Committee.  To expect patients and families to travel to Birmingham from remote areas of Lincolnshire, many of whom relied on public transport alone, was strongly opposed;

·       The consultation documents suggested that the average additional travel time for Glenfield patients to access services in Birmingham was 14 minutes.  Members were astounded at this statement as Birmingham Children's Hospital was 44 miles from Glenfield which was an impossible journey to make in 14 minutes.  By way of explanation, NHS England reported that the modelling exercise undertaken used the locations of current patients and the average travel time from each place.  It was agreed that NHS England would provide the detail on this modelling exercise as they accepted that this issue would require further consideration;

·       It was reported that an independent, external, company had been commissioned to analyse all responses to the consultation and assurance given, by Mr Huxter, that all members participating in that analysis would be independent to any of the centres involved in the consultation.  The Committee was also assured that all detailed responses would be taken in to account and coded to themes with all themes outlined within the body of the final report;

·       The Committee was concerned that one of the co-signatories on the consultation document was from Southampton Hospital, one of the centres included within the consultation.  The Committee also felt that the consultation questions had been written in such a way that the preferred outcome for NHS England would be automatically reached; that the centres were not on a 'level playing field' within the consultation; that the 'goal posts' for certain centres, including Glenfield, continued to move; and that continued support was provided to some centres by NHS England to remain open but not others, including Glenfield;

·       NHS England commended UHL on the pioneering work undertaken by UHL in relation to ECMO but insisted that this was also widely available in other centres which gave NHS England confidence in this service in the future.  When asked who provided the specialist training to these centres for ECMO, the response was UHL at Glenfield;

·       Glenfield Hospital also had a helipad to enable safe transportation of the mobile ECMO machine, other centres did not.  The Committee was dismayed that the proposal to close Glenfield had been made given this issue alone;

·       It was suggested that the consultation inferred that Glenfield was not currently safe for children to undergo surgery (again the Committee referred to paragraphs 39 and 40 of the full consultation document).  NHS England representatives stressed that there were no concerns about patient safety at UHL or from any other providers but that the proposals had been made in order to provide resilience in the future.

The Chairman thanked Mr Huxter and Dr Linehan for attending the meeting to address the Committee and confirmed that the Committee had not been reassured that the consultation process was fair and fit for purpose and, throughout discussion, continued bias against Glenfield Hospital was apparent. 

The Chairman confirmed that, legally, the Committee still had the option to refer this matter to the Secretary of State for Health in line with Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, following the submission of a response to the consultation.

RESOLVED

1.    That the information presented to the Committee on the consultation content and process be noted; and

2.    That the Committee consider this information during item 11 of the agenda – Congenital Heart Disease Services – Arrangements for Responding to the NHS Consultation.

At 11.40am, the meeting was adjourned to allow the Committee a short comfort break.

At 12.00pm, the Chairman reconvened the meeting.