Agenda item

Proposed Cllr Klara Sudbury

Seconded Cllr Chris Coleman

This Council is dismayed at the decision taken by the NHS community in Gloucestershire to permanently divert ambulances overnight between 8pm and 8am from CheltenhamGeneral Hospital to GloucestershireRoyal Hospital.

We are particularly concerned about the potential for increased mortality rates of patients being taken further across the county for emergency care, alongside the impact on waiting times at GloucestershireRoyal Hospital and on ambulance response times. We are also concerned that measures to mitigate access issues for Cheltenham patients being discharged from Gloucester remain uncertain.

In the light of the national review of urgent and emergency care, published on 17^th June, this Council agrees to write formally to the Board of the Gloucestershire Clinical Commissioning Group to ask that the decision to downgrade Cheltenham A&E should only be temporary to:

a) allow more time for local and national workforce issues to be addressed and

b) allow the impact of the downgrading to be properly understood by the health community and the County's Health, Community and Care Overview and Scrutiny Committee.

Councillor Sudbury, seconded by Councillor Coleman, proposed the following notice of motion.

This Council is dismayed at the decision taken by the NHS community in Gloucestershire to permanently divert ambulances overnight between 8pm and 8am from Cheltenham General Hospital to Gloucestershire Royal Hospital.

We are particularly concerned about the potential for increased mortality rates of patients being taken further across the county for emergency care, alongside the impact on waiting times at Gloucestershire Royal Hospital and on ambulance response times. We are also concerned that measures to mitigate access issues for Cheltenham patients being discharged from Gloucester remain uncertain.

In the light of the national review of urgent and emergency care, published on 17^th June, this Council agrees to write formally to the Board of the Gloucestershire Clinical Commissioning Group to ask that the decision to downgrade Cheltenham A&E should only be temporary to:

a) allow more time for local and national workforce issues to be addressed and

b) allow the impact of the downgrading to be properly understood by the health community and the County's Health, Community and Care Overview and Scrutiny Committee.

In introducing the motion, Councillor Sudbury, highlighted her concerns with the proposals which would result in 16 patients per night being transferred by ambulance to Gloucester. She referred to the recent meeting of the Gloucestershire Health, Community and Care Overview and Scrutiny Committee (HOSC) she had attended as a county member and had submitted an amendment. After considering the proposals and the results of the consultation, the HOSC had given a green light to the NHS proposals. It had been suggested that the low number of people responding to the consultation was as a result of the public not caring about the A&E service. However she argued that the poor response was due to a badly timed consultation and confusion caused by the changes being made to the PCT at the time. She had been disappointed in the way the HOSC meeting had been managed and felt members had been prevented from asking questions of the health professionals present at the meeting. She acknowledged that there were difficulties in recruiting the necessary consultants to ensure the safety and supervision of trainees in A&E. However she felt it would be a mistake to make a permanent change whilst trying to resolve these resource issues. Finally she referred to research made available by Martin Horwood MP where consultants had reported concerns about the potential impact of several minutes delay on cases needing the A&E service.

A member acknowledged it was a difficult area. He felt it was appropriate to challenge and seek reassurance on the proposed changes and monitor future performance. However he suggested that the temporary solution proposed in the motion may provide staff with more uncertainty and potentially make recruitment more difficult.  For that reason his gut feeling was that the proposal for a centre of excellence was the way to go in order to optimise patient care.

Another member felt that more work needed to be done on the wording of the motion as it was currently too weak to make any real impact. Another member suggested that the phrase "mitigate access issues" needed more clarification.

Several members expressed concerns about the changes being made to A&E and applauded the sentiments behind the motion.

Although well-intentioned and picking up concerns from the community, another member felt the motion was futile in what it could achieve. Council members were not experts and should acknowledge that HOSC had received a detailed presentation on this matter and were generally much more informed about health issues. He added that he had attended a consultation event and his initial dismay at the proposals had been allayed. He had concluded that although the proposals were not ideal, they would increase survival rates over the current arrangements, not to say that the current arrangements could not be improved. He concluded that it would take at least five to seven years to enable the shortage of consultants to be addressed and this could not be classed as "temporary". A preferable approach for the Council would be to call on the ambulance service to make adequate provision to support the new proposals. Far more important than the additional eight minutes for an A&E case to be taken to Gloucester, was that the patient should be directed to the appropriate specialist unit at the hospital when they arrived. 

Another member challenged the eight minutes as an underestimate of the time it would take, even for an emergency vehicle, to travel between Cheltenham and Gloucester. He emphasised that the thrust behind the motion was not to put in place a permanent solution whilst workforce issues were still being resolved. Changes to A&E should be made on the basis of clinical excellence and not be driven by workforce issues. His particular concern was that after treatment, patients could be left in Gloucester in the middle of the night without any transport home.

Other members spoke in support of the motion and felt it was important that they gave voice to the concerns of their constituents. Gloucester A&E did not currently appear to have surplus capacity so the outcome of the proposals could be that patients transferring to Gloucester end up having a longer wait.

The Leader of the Council felt this was an important debate and certainly not futile. Any response was urgent and therefore there was no time to set up a working group to look more closely at the issue. 

Councillor Hall, had attended the HOSC meeting as the borough council representative. She explained that she had worked for 10 years as a nurse in a minor injury unit  and as a result she could reassure members that nurses in these units were highly trained in emergency techniques. Unfortunately in the hospital she had worked in, it had not been viable to maintain those skills and therefore the unit had been closed down. With regard to Cheltenham General, they would have nurse practitioners in place who are highly training in A&E techniques. She described the HOSC meeting as ‘the nastiest meeting’ where members of the committee had been “between a rock and hard place”. Although no members had wanted to say yes to the proposals, the Hospitals Trust had been advised that from August 2013 it would no longer be able to utilise the junior doctors to fill the places of the middle grade doctors required on each rota. As the NHS had also informed the committee that it would take until 2020 to fill the additional consultants post, the committee felt they had no choice. For that reason members had felt their final resolution with the qualifications they added was the best that could be achieved in the circumstances. She was disappointed that Councillor Sudbury had not taken this motion asking for a temporary closure to the HOSC meeting. She felt she had already voted on Councillor’s Sudbury’s proposal at the HOSC meeting that the changes should be temporary for one year and on that basis would abstain from voting on the matter again.

As seconder of the motion, Councillor Coleman, urged members to keep a close eye on the proposals on behalf of their constituents. He repeated the figure previously stated that the proposals could mean as many as 6000 cases a year would have to travel to Gloucester. He too had attended the HOSC meeting and agreed with the sentiments expressed. He had been unhappy that important questions had not been answered and no assurances had been given by the health professionals that no lives would be lost as a result of proposals or that there would be no negative impact on patient care. In his view the proposals were not about improving medical care or providing a centre of excellence but were about staffing. For this reason and in order to reduce health inequalities across the town, he urged members to support the motion.

In her summing up, Councillor Sudbury responded to some of the points made by members during the debate. She felt a full calendar year would allow more time to recruit staff and address some of the resourcing issues. The “mitigate access issues" had been discussed at the HOSC meeting and referred to patients being potentially discharged in the middle of the night with no transport home. Finally she was concerned that this was the start of a path of further specialisation across the two sites which could result in no A&E facilities at all in Cheltenham in 10 years time.

Upon a vote on the motion was CARRIED.

Voting : For 28, Against 1, Abstentions 5.