Agenda item

Presentation and Q&A

The Chair welcomed the various representatives and thanked them for giving the committee the opportunity to better understand the process being undertaken by the Trust and to ask any questions and raise concerns. 

Deborah Lee, CEO (NHS Trust), Simon Lanceley, Director of Strategy and Dr Mark Pietroni, Medical Director (Gloucestershire Hospitals NHS FT), Mary Hutton, ICS Lead (CCG) and Paul Roberts, Joint Chief Executive (2Gether Trust) introduced themselves.

Mary Hutton talked through a PowerPoint presentation (Appendix 1).

4 written member questions had been received in advance of the meeting and these, along with responses, had been circulated to members (Appendix 2). 

The chair invited members to ask questions and asked that the relevant person respond.

·         A member queried how the Care Quality Commission report found that the Responsiveness domain ‘required improvement’ and yet Leadership was ‘good’; he also observed that some areas appeared to have gone backwards.  Deborah Lee said that there was not necessarily a correlation between the two; responsiveness in this context pertained to waiting times and whilst waiting times were not being met, this is not always with the control of the Trust’s leadership team, for example there had been a 40% increase in referrals which made meeting waiting standards very difficult irrespective of the quality of leadership.  Deborah Lee confirmed that not all services were inspected in 2019 and the ‘outstanding’ rating given back in 2017 had been retained by areas that were not inspected in 2019.  Some of the areas rated as ‘requiring improvement’ in 2017, had since been rated as ‘good’ and she was confident that the direction of travel was towards ‘outstanding’. More than 90% of Trust services are now rated good or outstanding compared with 73% two years ago. 

·         Deborah Lee reiterated the point made as part of the PowerPoint presentation that nothing had been pre-determined and there were no plans to close A&E in Cheltenham as had been suggested in the media.  She expressed her disappointment that the launch of the engagement process had not gone as planned and, as a result, misinformation was circulating which had caused anxiety for people.  The purpose of the engagement process was to allow the Trust and system partners to outline the challenges they faced, as well offering people the opportunity to give their view and suggest ideas on how the challenges could be addressed. The Trust and its partners in One Gloucestershire would then consider all of the feedback and through a two day ‘solutions workshop’ develop option which would go out for public consultation, if they constituted substantial variation to service.  

·         Professor Pietroni said that there was no single model for an Urgent Treatment Unit (UTC) on a hospital site but they would typically include a range of staff and would have a resuscitation facility to deal with any patient who presented with a life threatening condition. Type 1 A&E departments are designed to respond to life and limb threatening emergencies however, this was a complex issue, given that there were different categories of Type 1.  Southmead Hospital, Bristol for example, was a Type 1 facility and a designated Regional Trauma Centre. 

·         At this stage nothing was being discounted and if there was overwhelming support for the reinstatement of a 24hr A&E department at Cheltenham, then this would be considered, but it was noted that options which were consulted upon would be evaluated against a range of criteria and need to be deliverable; the constraints and challenges that existed today would in all likelihood still exist at that point and these would also be important considerations. 

·         If a patient having undergone planned surgery deteriorated (assuming the outcome of the engagement and consultation process was that emergency surgery was undertaken at one site and planned surgery undertaken at the other), the patient would only be moved to the other site if necessary, as services would remain on each site to deal with ‘deteriorating patients’.   

·         Specific workshops had been arranged for A&E and general surgery and the feedback considered, before locality events being held to discuss feedback and work through various options.  

·         The booked appointments model would be in addition to ‘walk in’ urgent care, where patients needed to attend hospital, but rather than going to A&E and face possibly waiting hours to be seen, they could instead make an appointment for later in the day;  It was suggested that this would be a  more attractive option as many patients that did not require emergency care.  An app which connected GPs to the relevant service, recorded conversations and saved them automatically into a patients records and allowed GPs and services to agree what needs to happen, could be rolled out to other services.  

·         One aim was to get the 25% - 33% of patients that accessed A&E and didn’t need to, to the right service in the first instance, rather than any attempt to redirect the 67% - 75% who required urgent care. 

·         In reference to the ‘centre of excellence’ model, the vast majority of people would continue to access urgent treatment at their local hospital, but that for an absolute minority of the most sick patients, whose outcomes would be improved if their treatment were given at a centre of excellence, an alternative pathway would be in place. DL said that local surveys showed that distance was a key factor for only 8% of the public when it came to accessing the most specialist care aimed at delivering better outcomes.

·         The Trust could continue trying to deliver all services from both sites but in reality this would result in services falling behind services from across the country.  The reason the Trust had one of the best cancer services in the country, was because this service was delivered from Cheltenham and not on both sites.  

·         Deborah Lee reminded members that they were in the stage of engagement and that consultation would not start until the spring of next year and at that stage they would welcome the opportunity to come back to the committee and discuss the various short listed options.   

·         This engagement stage formed part of a process set out by Government and she suggested that this was as frustrating to her as it was to members and the public as everyone was keen to get to the detail but she was hearing important views through the engagement phase and was grateful for this.  This period was about setting out the challenges being faced and inviting views and the One Gloucestershire system would simply be listening to those views at this stage.   

·         The CCG did have a map of the county and services provided at which locations but this had not been included in the engagement documentation. 

·         The CCG were aware of major development plans within Cheltenham and a Planning Group were working through spatial planning, but it was important to note that new homes would not necessarily result in more people.

·         All options would be underpinned by travel assessments, which would consider the cost implication for patients of getting home from an Emergency Department when it was further away from their home.  However, it was noted that feedback gathered some 18 months ago had demonstrated that enhanced outcomes for patients was more important than travel which came out as one of the least important factors.  

·         Asked about the ‘golden hour’ and ‘platinum ten minutes’ and the impact of having to go to one site over another, which could add 20 minutes to a patients journey, Dr. Mark Pietroni reminded members that patients would be cared for by highly skilled ambulance staff throughout their journey but also reassured them that if they presented at the wrong site, they would be stabilised and transferred as soon as possible. 

Comments from members included:

·         Members felt that there was insufficient information in the engagement document to enable people to give a view that it would therefore be very difficult to use that feedback to identify options.   

·         A member accepted the argument that in the quest for the best outcome, families would be comfortable with travelling longer distances for treatment.   

·          As well as keeping people out of hospital a member urged the NHS community to consider the consequences of discharging patients too soon, asking that they be aware of the implications on people not just the outcomes of their care.    

·         This issue had prompted more residents to contact one member, more than any other issue he could remember, and given the public feeling, he urged the Trust to make the right decisions.  

·         The same member felt strongly that this presentation should have been made to Council and not just the O&S Committee, and urged that any future presentations by made to Council instead.   

·         The additional pressure that would be placed on the ambulance service if more patients had to be transferred between two sites delivering different specialist care, needed to be considered.   

·         A member suggested that the clinicians and administrators, despite claims to the contrary, had already made a decision about the future of services at both sites, regardless of the outcome of the engagement and consultation process and challenged them to provide a 24/7 A&E department in Cheltenham.

The Chair thanked all of the representatives for their attendance, which was much appreciated by the committee and confirmed that it would be useful for them to return once consultation was underway and more information was available.  She asked that if one thing were taken away from this meeting, it should be that a 24/7 A&E service should be reinstated in Cheltenham.

The meeting was adjourned at 8.05pm and reconvened at 8.15pm.

Members felt that it would be useful to write to Councillor Allaway Martin, Chair of the Gloucestershire Health Overview and Scrutiny Committee and outline the concerns and other comments raised by this committee.  The Chair would draft something on behalf of the committee and send it ahead of the HOSC meeting the next day (10 September), asking that feedback from the HOSC on the issues that are raised in the letter.