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Healthcare for the Future – Recommendations of Clinicial Commisioning Group Governing Body

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The Cumbria Clinical Commissioning Group Governing Body held a meeting in public today (08th March) at the Oval Centre, Workington to make some important decisions for health and social care service delivery across west, north and east Cumbria.  This meeting followed on from the public consultation which took place at the end of 2016 which asked people to respond to options for possible changes. The consultation document highlighted the NHS preferred options. The responses to the consultation have now been analysed and members of the CCG Governing Body were asked to consider and decide on a number of recommendations.

Sue Stevenson, Chief Operating Officer of Healthwatch Cumbria reminded people at the start of the meeting  about the role of Healthwatch Cumbria on the CCG Governing Body which is to have observer status. This means that she does  not take part in a vote when decisions are made but  can ensure that members of the Governing Body are reminded of, and urged to take account of, the views and experiences of local people in the decision making process.  She emphasised that their views and experiences matter.

The following sets out the recommendations made to the Governing Body.  Full details of these will be available on the CCG website.

Maternity Services:

Option 2 – The original preferred option by the Success Regime was Option 2 which was the provision of a consultant led maternity unit, alongside a maternity led unit at Cumberland Infirmary Carlisle (CIC). At West Cumberland Hospital (WCH) there would be a midwife led maternity unit for low-risk births with consultants available for ante natal and post natal consultations during a 12 hour period during the day. A dedicated ambulance would be provided to transfer any women in labour who needed to be treated at CIC.

Option 1 was the provision of a consultant led maternity unit at both CIC and WCH.

Option 3 was a consultant and midwife led unit at CIC with no births at WCH – there would be consultants and midwives for ante natal and post natal care only.

The following recommendations were agreed:

Recommendation 2.1: To test the viability of Option 1 over a 12 month period.

Recommendation 2.2: If Option 1 is not proven to be deliverable or sustainable then implement Option 2 at the end of the 12 month period.

Recommendation 2.3: Whilst testing Option 1, to prepare for Option 2 by implementing a Midwifery Led Unit (MLU) in Whitehaven alongside the Consultant Led Unit, in order that the MLU can be audited as if it was freestanding.

Recommendation 2.4: To implement Option 3 if Option 1 is not proven to be deliverable or sustainable and, following audit of the MLU, Option 2 is not deemed to be safe.

It was further agreed that an independently chaired “co-production” steering group to test the sustainability and deliverability of Option 1.

Paediatric Services

The NHS preferred option for Children’s Services was for Option 1– CIC would have a inpatient children’s unit service West, North and  East Cumbria. WCH would have a short-stay assessment unit, with some overnight beds for children with less acute, low risk illnesses but could be transferred to Carlisle (CIC) if needed.

Option 2 – CIC would have an inpatients children’s unit along with a short stay assessment unit. WCH would have a short stay assessment unit but no overnight beds.

Option 3 – CIC would have an inpatients children’s unit along with a short stay assessment unit. WCH would have an outpatient children’s service only with no short stay assessment units.

The following recommendations were agreed:

Recommendation 3.1: The Governing Body is requested to approve Option 1 for implementation.

This option involves the development of an inpatient paediatric unit serving West, North and East Cumbria based at Cumberland Infirmary Carlisle along with a Short Stay Paediatric Assessment Unit. At West Cumberland Hospital, Whitehaven, there would be a Short Stay Paediatric Assessment Unit for children requiring short term observation and treatment. There would be some overnight beds at Whitehaven for children with less acute, low risk illnesses but children who needed more acute inpatient admission would be transferred to Carlisle.

Recommendation 3.2: The Governing Body is requested to approve that should Option 1 ultimately prove to be unsustainable then Option 2 for Children’s Services may need to be implemented..

Community Hospitals

The NHS preferred option for the consultation was Option 1 – this was to keep all community hospitals open but to consolidate 104 hospital beds into six sites  -Whitehaven, Cockermouth, Workington, Penrith, Brampton and Keswick.

Option 2 was to consolidate 104 beds into 5 sites -Whitehaven, Cockermouth, Penrith, Brampton and Keswick

Option 3 was to consolidate 104 beds into 5 sites  -Whitehaven, Workington, Penrith, Brampton and Kewsick

Option 4 was to consolidate 104 beds into 3 sites – Whitehaven, Penrith and a new site in Carlisle.

Before moving to a decision, Governing Body members discussed the proposals emerging for innovative and wide-ranging ideas for role of community hospitals and the services they can deliver for the local populations. The most development proposals have come forward from Maryport, Wigton and Alston.

The following was recommended:

Recommendation 4.1: The Governing Body is requested to approve Option 1 for implementation.

This option includes the consolidation of inpatient Community Hospital beds into six sites. In total there would be 104 inpatient beds at Whitehaven (Copeland Unit), Cockermouth, Workington, Penrith, Brampton and Keswick.

The Governing Body is requested to endorse the following actions:

A process of co-production with stakeholders in each of Maryport, Wigton and Alston should continue. It is anticipated that co-production will lead to further proposals within the next twelve months, as part of the plans to implement Integrated Care Communities. Any such proposal will require further consideration and approval by the NHS Cumbria Clinical Commissioning Group Governing Body and the broader West, North and East System Leadership Board prior to implementation.

Emergency and Acute Care

The NHS consultation preferred option was Option 1 – This involves a 24/7 A&E at Cumberland Infirmary Carlisle along with acute medical inpatient services. There would be assessment and inpatient beds for the frail elderly, as well as specialist rehabilitation. The number of intensive care beds currently on site would increase slightly, as would the number of emergency assessment unit beds.

At WCH here would also be a 24/7 A&E along with acute medical inpatient services and rehabilitation. There would also be a small intensive care unit but some of the most seriously ill patients would be transferred to Carlisle if it was felt they would benefit from the extra support there.

Option 2 was 24/7 A&E at CIC and acute medical inpatient services. At WCH there would be a daytime only A&E with a 24 hour urgent care centre. There would be no intensive care unit at WCH but there would be specialists able to provide emergency care for those who needed  treatment before transfer.

Option 3  – An increased 24/7 A&E facility at CIC. At WCH there would be no A&E unit and not intensive care unit but there would be a 24 hour urgent care unit.

The following recommendation was agreed:

Recommendation 5.1: The Governing Body are requested to approve Option 1 for implementation.

This involves a 24/7 A&E at Cumberland Infirmary Carlisle along with acute medical inpatient services, including for the most complex cases. There would be assessment and inpatient beds for the frail elderly, as well as specialist rehabilitation. There would also be a 24/7 A&E at West Cumberland Hospital along with acute medical inpatient services and rehabilitation. There would also be a small intensive care unit but some of the most seriously ill patients would be transferred to Carlisle if it was felt they would benefit from the extra support available there.

Note: This will not change the bed base of the Intensive Care Unit at West Cumberland Hospital. This will also not change the previously implemented high risk pathways including those relating to cardiology and respiratory.

Hyper-Acute Stroke Services

The NHS consultation preferred option was Option 2  – a single hyperacute stroke unit at CIC with ambulances taking possible stroke patients straight to CIC.

Option 1 would largely maintain services as they are now.

Recommendation 6.1: The Governing Body are requested to approve Option 2 for implementation.

This would see all acute stroke cases managed in a single hyper-acute stroke unit based at Cumberland Infirmary Carlisle. Ambulances would take possible stroke patients direct to Carlisle. Patients arriving at West Cumberland Hospital by other means would be transferred by ambulance to Carlisle. On leaving the hyper-acute stroke unit patients resident in West Cumbria would be transferred to acute stroke and rehabilitation facilities at West Cumberland Hospital if further hospital care was needed. This service would be complemented by ensuring improved, early supported discharge in both Carlisle and Whitehaven.

Emergency surgery, trauma and orthopaedic services

The proposal consulted on the arrangements previously made for general surgery and trauma and orthopaedics on safety grounds last year are now made permanent but with some further changes which allow additional emergency surgery and trauma care to take place at West Cumberland Hospital

The following recommendation was agreed:

Recommendation 7.1: The Governing Body are requested to approve the proposal set out in the Public Consultation document for implementation

In addition a number of supplementary endorsements were agreed for each decision to support effective implementation. The Governing Body also  agreed  the following:

Recommendation 8.1: The Governing Body is requested to approve the formation of an Implementation Reference Group to feedback on the implementation process. The membership of this group will be agreed in discussion with patient and the public representative groups, stakeholders and partners but would include representation from the clinical commissioning group including the Lay Member Lead for Patient Engagement and the Medical Director.

As the independent consumer champion for health and care services,  Sue Stevenson offered  HWC’s support to work with local community groups to ensure that people are directly involved in this process.

Cumbria Partnership NHS Foundation Trust have released the following information following today’s meeting:

CEO pays tribute to work of community groups as CCG take ‘difficult but right decision’

The Cumbria Clinical Commissioning Group have also published a press release regarding the decisions made:

Healthcare for the Future – Decisions