A leading South Cumbria consultant said the people of Furness were being given a raw deal over plans to downgrade critical care in the town.
Speaking exclusively to Cumbria Crack, and on condition that their name would not be revealed, they said they were compelled to come forward as they feared for health services in the area.
Last month, the Lancashire and South Cumbria Integrated Care Board said the highest level of critical care would not return to Furness General Hospital in Barrow.
It had been suspended since September due to recruitment issues.
The three levels of adult intensive care are defined by the intensity of organ support and monitoring required.
Level 1 is for patients at risk of their condition deteriorating, requiring additional support and monitoring on a regular ward.
Level 2, also known as high dependency, provides support for a single failing organ system or post-operative care.
Level 3, the most intensive level, involves support for two or more failing organ systems, including mechanical ventilation.
While the temporary change has been in place, patients who required Level 3 critical care were transferred to Royal Lancaster Infirmary, once stabilised.
Patients who needed levels 1 and 2 critical care continued to be treated and cared for at the hospital in Barrow.
Managed decline
But the consultant fears that the trust which runs the hospital had given up – and instead, the hospital was in managed decline.
The consultant said: “Furness General Hospital is a really good hospital and serves the needs of its population very well as it has done for decades.
“Intensive care is a central part of providing safe services across all areas – any hospital treatment can have problems that develop.
“Sepsis is a lot of the work which level 3 intensive care does as it’s the main cause of organ failure.
“In maternity, surgery, general medicine and paediatrics it can occur anywhere and can rapidly lead to someone who is deteriorating extremely quickly needing expertise and facilities to stabilise the patient.”
Incentives to work in Barrow
The challenges faced in providing healthcare in a relatively remote area that is home to three of the most deprived council wards in the UK is not lost on the consultant.
They said: “In some respects it is like working within an inner city area with some having higher health requirements.”
When it comes to attracting clinicians to work in the area, decades of experience has helped influence their views on how best to recruit, they said.
They added: “It is about money. The area is remote, the opportunities to bolster income with private work are few and we are in global market when it comes to recruitment.
“But not offering incentives [that others do] means the trust are always going to struggle to attract interest. The NHS in Blackpool was able to use incentives to recruit so we’re facing competition even within this region.”
How many people will the changes affect?
The ICB claims that in the first six months since the temporary suspension of Level 3 care at Furness General Hospital, 30 patients have been transferred ‘to a different provider’. It added that 10 would have been transferred, even if there had been a Level 3 unit at Furness General Hospital due to clinical needs, and there had been no adverse outcomes.
Those figures are questioned by the consultant.
They said: “Our data showed that in fact the number of people who we saw at Level 3 stabilisation at Furness General Hospital was 56 with only 32 were transferred to Lancaster. Only three were transferred to other trusts for specialised care.
“There will always be patients who require Level 3 care because they’re extremely sick, but the numbers used to support this proposal are only those who require ventilation for over eight or nine hours.”
They said their data was based on figures submitted to the Intensive Care National Audit and Research Centre, an independent, not-for-profit organisation not linked to the NHS. The data is used to compare mortality rates among hospitals across the country with the aim of signalling ways of improving procedures.
That data said 21 patients were managed wholly at Furness General Hospital either because step down to Level 2 care was expected or because the patient was too unstable to travel.
Staffing issues
We asked how the lack of staff, claimed as the reason for the permanent move away from Level 3 care, was affecting care.
The consultant said: “We do have a rota that doesn’t have holes in it. There are clinicians who are trained to provide appropriate intensive care support during the 9-5 working day and then senior anaesthetists out of hours to provide ongoing support currently with ICM consultants on the phone from Lancaster.
“Once you have that capability it doesn’t require a great deal more to meet the standards to maintain that level of care. In the longer term, we will lose skills and won’t be able to recruit.”
Trust staff, it is claimed, were led to believe the change in care last September was temporary while further appointments were made before a final decision was taken. New appointments were made, reducing the need for locum support, and intensive care staff were anticipating the reinstatement of Level 3 care.
The consultant has called the trust’s plans a ‘treat and transfer’ service.
They added: “Leadership of the trust is ‘this is what is going to happen’ – it isn’t inclusive when you’re talking about very senior clinicians who have been working in the area for a very long time.
“I think the people of Furness are getting a raw deal.”
Independent review
The board said at the time of its decision, it had asked the Clinical Senate to carry out an independent review to advise on the safety and sustainability of the service going forward – taking into account the recruitment efforts since the temporary change was made.
Experts within the Lancashire and South Cumbria Critical Care Network were also asked to ensure the work done to date meets the national safety standards required.
It said at the time that following the review’s publication, it decided that the preferred option is to make this temporary suspension permanent.
The senate, which signed off the proposed changes, was chaired by Professor Martin Vernon, a consultant geriatrician and clinical director of integration with Tameside and Glossop Integrated Care NHS Foundation Trust.
The review’s conclusion said: “In their discussion with staff at Furness General Hospital, the panel were however concerned about the apparent lack of a staff vision for how the new service model would be achieved.
“Of particular concern to the panel were the strongly expressed views of clinical colleagues we spoke to who clearly wished, and appeared to be actively working towards, reinstating a Level 3 ICU.
“This suggested to the panel a disconnect between senior leadership and clinical staff narratives about critical care services at Furness General Hospital which requires urgent managerial attention.”
