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CCG to test viability of consultant-led maternity care at the West Cumberland Hospital

[N]HS Cumbria Clinical Commissioning Group’s (CCG) Governing Body met today to discuss and make decisions about the future of healthcare in west, north and east Cumbria.

The options were the subject of a public consultation between September 26 and December 19 2016.

The meeting considered recommendations developed from the options consulted upon, in light of the public feedback, and following subsequent clinical workshops.

The Governing Body decided:

Maternity

To implement and test the viability of Option 1. To maintain consultant-led care at the West Cumberland Hospital, with some high risk women giving birth in Carlisle.

During a 12 month period there will be an Independent Steering Group established to involve the community working in partnership with health professionals (co-production) to enable the very best efforts to be made to tackle the challenges the service faces, particularly around recruitment and retention of key staff, especially in paediatrics and anaesthetics. An important element of this co-production work will be an independent review of anaesthetist recruitment in relation to maternity services undertaken by the Royal College of Anaesthetists as soon as is practically possible.

At the same time there will be the development of an alongside midwife-led unit at the West Cumberland Hospital. The unit will be assessed as though it were ‘free-standing’ to better understand the level of risk to expectant mothers and babies.

If Option 1 is not proven to be deliverable or sustainable then Option 2 should be implemented at the end of the 12 month period (Consultant Led Unit and alongside Midwifery Led Unit at Cumberland Infirmary Carlisle and a standalone Midwifery Led Unit at West Cumberland Hospital).
If following the audit of the midwife led unit, Option 2 is not deemed to be safe, then Option 3 should be implemented. (Option 3 is a Consultant Led Unit and alongside Midwifery Led Unit at Cumberland Infirmary Carlisle and no births at West Cumberland Hospital).

Paediatrics

To implement Option 1. This option involves the development of an inpatient paediatric unit serving West, North and East Cumbria based at the Cumberland Infirmary in Carlisle along with a Short Stay Paediatric Assessment Unit. At the West Cumberland Hospital in 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.
The Governing Body agreed that if Option 1 ultimately proves to be unsustainable, then Option 2 for Children’s Services may need to be implemented. This would mean no paediatric overnight beds in Whitehaven.

Community Hospitals

To implement Option 1 which will see 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. However the Governing Body support this being implemented in a phased way through the proposals developed by the communities, in Alston, Maryport and Wigton, over the next few years.

Emergency and Acute care

To implement Option 1. This will see 24/7 A+E services maintained at both the Cumberland Infirmary in Carlisle and the West Cumberland Hospital in Whitehaven. An intensive care unit will be retained at Whitehaven, with the most seriously ill patients transferred to Carlisle. This option will also see the development of an innovative, ‘composite’ workforce model developing staff to cover a wider range of roles.

Hyper acute stroke services

To implement Option 2. This will see a hyper acute stroke unit (HASU) developed at the Cumberland Infirmary in Carlisle, with all possible stroke patients taken directly to the unit, and any arriving at Whitehaven transferred to Carlisle for assessment and treatment by a specialist multi-disciplinary team. Rehabilitation services will be maintained at the West Cumberland Hospital.

Emergency surgery, trauma and orthopaedic services

The Governing Body agreed to make permanent the earlier interim changes which saw the centralisation of emergency complex trauma and orthopaedic surgery at the Cumberland Infirmary.

This will also see more minor trauma surgery carried out at the West Cumberland Hospital along with some non-complex day case surgery. There will also be additional outpatients fracture clinics introduced at the West Cumberland Hospital.

NHS Cumbria CCG’s chief executive Stephen Childs said: “We have listened to the feedback we received during the public consultation. We have been very clear about the challenges we face and members of the public have shared their concerns about the risks. We hope we have found a way forward, but we will need the support of everyone – NHS staff, the community, the groups we have been engaging with throughout the process as well as other health professionals, to try to ensure safe and sustainable services into the future. The output of the independent review of anaesthetist recruitment to be carried out by the Royal College of Anaesthetists will provide further valuable insight.

“We know it won’t be easy, but we also know there is a great energy and passion for the NHS and we want to harness every opportunity to create the best outcomes for Cumbria.”

The Governing Body also found that the public consultation had been carried out to a highly satisfactory standard, meeting the independent Consultation Institute standards to be rated ‘best practice’.

It also outlined a process for ensuring that implementation plans are drawn up with appropriate staff, clinical and community engagement, and to ensure the new services are introduced safely.

The meeting was held at the Oval Centre in Workington and observed by members of the public, including health and local authority partners, and representatives of community and campaign groups who have been involved over recent months.

The decisions will be considered by Cumbria County Council’s Health Scrutiny Committee later this month.

Dr David Rogers, Medical Director of NHS Cumbria CCG, said: “Firstly we would like to reassure our community, patients and staff that no services will change overnight. Robust plans will need to be in place before any changes occur. We will need the community’s support to enable us to ensure the transition of these services safely over time. We have listened to both the public and the experts and do believe that a genuine coproduction is the best way forward to ensure the best possible services for our patients and public’’.

“This process has been about ensuring safe and sustainable services for our community, and that continues to be our priority in the coming weeks and months.”

A spokesperson for NHS England and NHS Improvement Cumbria and the North East, said: “The West, North and East Cumbria Success Regime, which was established in autumn 2015, had the very important and difficult task of looking at how to tackle long-standing problems within the health system in the area, with a focus on recruitment, finance and quality of care.

“We appreciate that changing the way people access health care may cause concern. Views from a vast number and range of organisations and individuals have been taken into account as part of the consultation and Cumbria CCG’s decision making process. With regard to maternity services, additional information from an independent review by the Royal College of Anaesthetists, due to take place during April and May this year, will provide further important detail to assist with the implementation of proposals.

“The priority has to be to secure the future of health care in Cumbria, and to ensure patients receive the best possible care, which is sustainable, safe and affordable.”

Claire Molloy, the Chief Executive of Cumbria Partnership NHS Foundation Trust has paid tribute to the work of community groups in Cumbria as NHS Cumbria Clinical Commissioning Group decide to approve the preferred option (option 1) to close beds in Maryport, Wigton and Alston but crucially to implement this through the work that has been undertaken by the community groups.

Claire Molloy said, “I think the Clinical Commissioning Group has made the right decision under very difficult circumstances. Their decision, which our Board of Directors supports, provides the right balance between being able to operationally sustain community hospital beds and our ambition to provide more care out of hospital in our communities.

“We are facing significant operational difficulties in staffing the in-patient wards day in day out and the inpatient ward at Alston is very fragile currently. It is not fair to our staff or our local communities to continue in this way and temporary closures of these units will continue unless we do things differently.

“We also know that the national and local evidence shows that we need to provide more care outside hospital setting. Supporting patients at home is better for them: if we can get the system working well, it is proven to have faster recovery times  – we have seen this with the hospital at home service in Carlisle for example.

“Following the decision, I am clear that changes will not happen overnight – it is likely that they will be phased over the next few years and the timescale is ours to determine. We will only close beds when we are confident in alternative service models unless we have to in order to ensure a safe service.

“I did say at the start of this process that we needed to come up with a more attractive offer for the people of Alston, Wigton and Maryport and by working with partners and community groups we have been able to make a great deal of progress.

“In Maryport we believe we have found a way to improve community services to reduce the reliance on community hospital beds.

“In Alston and Wigton there is more work to do with partners and communities to develop the options. This is the start of that step change we must take on our journey to develop integrated care communities and provide more care outside hospital settings.

“The decision has been significantly improved through the hard work, dedication and spirit shown by groups of people in our communities who have been willing to bring their ideas to the table and really get to know the challenges that we face. I especially want to thank the community hospital league of friends in Maryport, Alston and Wigton, the Maryport save our beds and other local community groups, local GPs, and staff who have come together to find a way forward that gives our communities a better deal.

“Now it is important that we progress the proposals with community groups having a real opportunity to influence change to develop healthcare for the future.”

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