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Clarifications about the Our Health Our Care programme in central Lancashire

23rd August 2019

The Our Health Our Care programme would like to offer clarifications to remarks made in relation to a Royal College of Emergency Medicine (RCEM) report concerning services at Lancashire Teaching Hospitals NHS Foundation Trust as well as options for delivering an agreed future model of care for central Lancashire.

The Royal College of Emergency Medicine is an independent professional association of emergency physicians representing the entire country and is entirely separate from the Our Health Our Care programme. 

A panel of experts, including a lay member, visited both Chorley and South Ribble and Royal Preston Hospitals to conduct their analysis, as referred to in this morning’s report. 

During this two day visit the review team spoke to dozens of senior doctors, nurses and others working at both hospitals, who offered their own experiences and opinions around working at both sites, backed up by the clinical data they provided. 

Their honest conclusions are based on their entirely independent assessment of services and what they heard from clinical professionals during the visit.  In reality, this was the doctors, nurses and others who care for the people of Chorley, South Ribble and Preston every day – and are well placed to say what they think is best for patients.

The public would expect that their local clinical commissioning groups, formed of local people and clinicians who live, work in and represent your community, take an honest, thorough report such as this into account when developing its plans. 

None of our 13 options will be implemented unless they can be demonstrated to be safe, clinically viable, and provide a sustainable solution to the challenges faced by the NHS in central Lancashire.

The programme has also been clear that we would welcome significant capital investment in central Lancashire to further improve hospital and community services for patients in Chorley, South Ribble and Preston.  We will continue to push hard to achieve this, working together with our partners. 

Our vision in the programme remains absolutely clear: we want to deliver the best possible clinical outcomes for people in central Lancashire.

 

FURTHER CONTEXTUAL DETAIL

  • Communications with MPs and others 

The programme has offered to meet all local MPs to discuss the proposals and continues to involve all relevant organisations in the development of its plans, including local authorities.

In these and other meetings, the programme remains clear that a range of options equally remain under consideration.  These options take in to account a whole range of factors, focussing on what can be delivered safely, effectively and sustainably for local people, and how we respond to population levels, changing healthcare needs and the current performance challenges faced by our health system. 

As part of this, the Our Health Our Care programme is concerned with improving access to primary care services and preventing ill health, as well as transforming hospital services for the future.  This would involve providing more and better care closer to home, responding properly to the changing needs of the population that our health services provide for and taking action on areas that people have said they are concerned about, such as a lack of joined up services and not being able to get access to a GP appointment. 

  • Options/Consultation:

As the report published notes, further work is taking place around the A&E model at both sites, reflecting our continuing open-minded approach. 

The joint committee of the clinical commissioning groups will consider the recommendations next week and are carefully scrutinising the programme at each stage, to make sure that the best outcome for patients is delivered.  Significant clinical assessment and scrutiny of all the options will continue to take place.

No option will be implemented by the programme unless it can be demonstrated to be both safe, clinically viable and sustainable for the future.  We have not identified a preferred option from those published and it will be some time before we are in a position to be able to formally consult on the options developed.

  • Consultation Process:

As the report notes, we are considering evidence thoroughly and from a range of different sources.  Any consultation about the programme options will be open, honest, and fair, allowing everyone an opportunity to have their say. 

No decisions about the options will be taken until after such a consultation has taken place.

  • Capital:

The programme has also been clear that we would welcome capital investment in central Lancashire to further improve hospital services for patients in Chorley, South Ribble and Preston. 

The report notes how we have already explored ways of trying to make this happen and how we will continue to do so.  This approach includes working with politicians and others who may be able to support our plans for capital investment in central Lancashire.

 

FREQUENTLY ASKED QUESTIONS:

Have you done everything possible to solve the staffing issues?

Yes, health care providers have taken a number of actions to help recruit more staff the past few years and continue to actively recruit to fill vacant posts. This is an issue that is impacting the whole of the NHS and is not exclusive to our area. There is a national shortage of many specialty staff including A&E doctors, elderly medicine physicians and a range of other clinical professions.  There are proportionally more vacancies in the north of England than anywhere else in the UK.

Just some of the actions health care providers have taken over the past couple of years include:

  • Working with Health Education North West to look at the reallocation of training posts across the North West
  • Raising the profile of the Trust and vacancies nationally through:
    • Constant advertising posts on the national NHS Jobs website
    • Exhibiting at national recruitment conferences
    • Developing a promotional DVD to attract doctors to the trust
    • Advertising posts through other networks such as Doctors.net
  • Proactively recruiting from non-UK sources including:
    • International recruitment
    • Undertaking Skype interviews to support international recruitment
    • Working with an organisation that supports overseas doctors to gain GMC registration as a source of recruitment
    • Supporting a number of Medical Training Initiative (MTI) schemes and applications. The MTI is a mutually beneficial scheme that provides junior doctors from all over the world with the opportunity to work and train in the UK
  • Proactively delivering contract and pay actions:
    • Appointed GPs to Trust contracts
    • Offered Trust contracts and contracts for service
    • Enhanced the internal bank rate of pay
    • Enhanced terms and conditions for specialty doctors, e.g., increased annual leave and training time
    • Introduced a local recruitment and retention premium for middle grade doctors in the emergency department in order to try and attract these doctors to come and work for us
    • Taken the decision not to implement the national agency cap for Emergency Department posts
  • Implementing role substitution through nurse clinicians, physicians associates, and advanced nurse practitioners and pharmacist prescribers
  • Offering joint academic or research posts
  • Filling substantive posts on a temporary basis with locum doctors either through NHS contracts or through locum agencies
  • Developing a Trust-wide vacancy management strategy with a clear focus on improved marketing, role substitution and the use of alternative recruitment sources

Did the previous downgrading of Chorley A&E have a negative impact on the Preston site?

The majority of patients attending Chorley during this period were seen by the urgent care centre (UCC). There was an increase in attendance at Royal Preston Hospital, and both Wigan and Blackburn saw a small number of additional patients.

Did the previous downgrading of Chorley A&E have a negative impact on other hospitals – in particular Wigan?

The urgent care centre provides safe and effective treatment for the majority of patients who attend Chorley. There, the majority of patients presenting to Chorley A&E were still able to be treated locally by the UCC service. Some patients chose to attend the Preston site and a small number attended other hospitals (patient outflows were limited).

When Burnley closed and everything went to Blackburn, Blackburn couldn’t cope. That shows that that model doesn’t work.

There is no single option which proposes the closure of Chorley hospital. When the A&E was closed temporarily in 2016, it was a rapid response to a staffing crisis. Any future changes will be planned and worked through. Nationally there is a staffing crisis, so we need to look at how we can provide safe, high quality emergency care with the staff levels that are available to us. Urgent care centres can treat around 80% of the patients who attend A&E, which will mean less demand on A&E services. 

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