Cumbria Crack

Update on decisions made as part of Healthcare For The Future one year on

stethoscope[H]ealth and care leaders are updating the community on progress a year on from the meeting where decisions were made following the public consultation into six NHS services.

Since the Healthcare For The Future public consultation which ran from 26 September to 19 December 2016, there has been considerable work in order to assure the transition of services made in a safe and sustainable way. The service changes consulted on were maternity, paediatrics, community hospitals, stroke services, accident and emergency and emergency surgery, trauma and orthopaedics.

The decisions were made at a meeting in public by NHS Cumbria Clinical Commissioning Group’s (CCG) Governing Body on March 8th in Workington.
Progress has been made by health and care providers and commissioners across north Cumbria and monitored by NHS North Cumbria CCG.

Chief executive of NHS North Cumbria CCG Stephen Childs said: “We know the challenges we shared with our community during the consultation were very difficult, and that people care passionately about their services with many people and groups putting a lot of time and effort into their responses to the consultation.

“We listened very carefully to what people told us and we reflected their concerns in our decisions by including the important role of patients, communities, frontline staff and the third sector in shaping the implementation of the decisions. We greatly value the role they can play in helping us meet our challenges ahead.

“We heard loud and clear that the NHS alone does not have all the answers, and we are very pleased to have started working much more openly and collaboratively with people who want to make a positive and constructive contribution to the future direction of our services.”

The process of working with the community is called co-production and several working groups have been established. They are working actively to look at the opportunities offered in areas such as telemedicine, as well as for fresh answers to difficulties in recruiting health care professionals, particularly specialists.

Information about meetings, issues being considered and how you can get involved is on the CCG website at:

The leader of the North Cumbria Health and Care System, Stephen Eames, said: “There has been a huge amount of work to make changes to the services we consulted on and change the way we work with our communities. We can have no doubt we have come a long way in the last 12 months.

“The system needed to make these changes to vulnerable services to ensure safe and sustainable provision for the future.”

The challenges largely come from recruitment of specialists in roles where nationally there is a short supply – these include:

  • paediatric consultants
  • anaesthetists
  • stroke physicians
  • middle grade obstetricians.

Updates on the decisions are listed below:

Accident and Emergency
Despite serious challenges to staffing, the decision was made to retain A&E services at both the Cumberland Infirmary Carlisle (CIC) and the West Cumberland Hospital (WCH).

The most challenging staffing issues were at WCH therefore an innovative new staffing model in acute medicine, the ‘composite workforce model’ has been introduced which means traditional non-training junior and middle grade medical roles can be replaced by suitably trained and experienced clinicians from a variety of clinical backgrounds. The roles include advanced clinical practitioners, academic fellows, GP trainees and physician
associates. This shores up the acute medicine service which supports emergency care.

The model won the ‘Innovation in HR’ award at the 2017 HPMA awards and the Royal College of Physicians also paid tribute to the innovation when the President, Jane Dacre recently visited the Trust. Her feedback included: “I think the work done at Whitehaven in the creation of the Composite Workforce is really innovative, and should be shared nationally as an example of good practice. I left feeling quite inspired by what you have all
achieved. So keep going!”

Community Hospitals
The decision to consolidate inpatient beds across six sites and the closure of in-patient beds at Alston, Maryport and Wigton was opposed by those communities. However since the decision has been made, it has provided an opportunity to help shape services to support those communities in alternative ways.

This has meant the NHS, social care, third sector, primary care and community members sitting together to assess the needs of that community and consider alternative provision, especially for frail elderly and palliative care cases that should be offered care close to home.

These community alliances have also considered the care and treatment of people in these areas, the amount of travel from those communities to treatment appointments and develop plans to bring some closer to home.

Progress has been different in all three locations and each area has developed a plan for new services which will be considered by NHS North Cumbria CCG’s Governing Body in April.

The bed closures are anticipated over the next 8 months.

Emergency Surgery, Trauma and Orthopaedics
The consultation considered changes made on safety grounds in 2013 regarding moving emergency complex surgical services from WCH to CIC. The service changes have proved to be beneficial for patients across north Cumbria with mortality rates and outcomes improving, therefore the consultation decision was to make the changes permanent.

The consultation also focused attention on the journeys made by some people with lower level trauma which could be done safely at WCH.

In Orthopaedics, an additional theatre has opened to allow for a further increase in surgery of up to 25 percent. Approximately 70 percent of the Trust’s planned orthopaedic operations are already now carried out in the new theatre facilities in Whitehaven.

The team also now runs a theatre list at WCH every week for minor trauma surgery and trauma cases are also added to existing orthopaedic theatre lists as demand dictates. This arrangement efficiently matches current levels of demand for non-major trauma surgery in West Cumbria.

In addition to Orthopaedics, work has been ongoing on a range of further developments in surgery at WCH, including:

  • Breast surgery including guide wire procedures and breast symptomatic clinics
  • Thyroid surgery
  • Urology including day case prostate resections using green light laser (only available at WCH)
  • Oral surgery
  • Orthodontic treatments
  • Upper GI surgery – additional operating lists and clinics
  • Manometry investigations

Hyper Acute Stroke Unit
There are huge pressures on the stroke team serving north Cumbria, which also sadly lost Professor Olu Orugun – one of the service’s biggest champions – during 2017.

There are national shortages of stroke consultants and stroke nurses and the need to make the best use of those precious resources has never been greater. There have been significant challenges in designing a service that will work for north Cumbria with requirements to increase beds at CIC and invest in equipment.

The opportunity has been taken to redesign an early stroke service discharge pathway – which means getting people home or closer to home more quickly – to ensure that patients from west Cumbria who may travel further for treatment immediately after stroke can return to WCH for rehabilitation after that initial acute phase.

The changes require investment, and while those plans are formalised clinicians will take part in public workshops to ensure the patient, family, carer and community voice shapes future plans.

The decision was to support consultant –led maternity services at both Whitehaven and Carlisle and to test the viability of delivering a sustainable service over a 12 month period, which it has since been agreed will start in April 2018.

There has been a huge amount of concern, challenge and suggestion about the future of maternity services at WCH.

This decision was referred to the Secretary of State for Health by Cumbria County Council’s Health Scrutiny Committee. A decision was received at the end of November 2017 and some work couldn’t be started before that clarity was given.

Alongside midwifery-led care has been established at CIC and WCH. Co-production – working together with the community – is becoming established and an Independent Review Group of clinical experts has been convened to review progress.

Work to establish Option 1 is underway – identifying the 100-200 women a year who will be booked to give birth in Carlisle because of the stronger paediatric service to support babies who may need more care.

Work to establish Short Stay Paediatric Assessment Units (SSPAU) at CIC and WCH is progressing. This model is used extensively across the UK and reflects the changing nature of childhood illness – most children admitted to hospital are discharged within 24 hours. We know the remote and rural nature of our geography means we can’t lift a model off the shelf, we have to make sure it works for us and we will phase in this service with no change to overnight beds at WCH in the first phase. The changes will start in the next couple of months.

How can you get involved in working with health and care system to sustain our services?
There is information on the CCG website about the working groups and meetings are held regularly in public and open to all who want to offer constructive support.

You don’t need any special qualifications or experience, and in our sessions there are no stupid questions or suggestions – everyone gets the chance to be heard.

So far our co-production work has helped support the establishment of telehealth pilots to support a potential reduction in journeys, helped shape how new maternity services can be audited and explore ways to welcome new recruits to Cumbria and support their families to settle here.

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