Agenda item

To consider NHS England’s proposals for the future provision of congenital heart disease services with particular reference to University Hospitals of Leicester NHS Trust.

Following the publication of NHS England’s proposals on 8 July 2016 Leicester City Council and Leicestershire County Council considered the issue and extract of their decisions at attached at Appendix B (Page 5). 

Rutland County Council’s Health and Wellbeing Board will consider the issue at its meeting on 27 September 2016.

The City Council’s Health and Wellbeing Board received a report from NHS England and a submission from the University Hospitals of Leicester NHS Trust (UHL) at their meeting on 18 August 2016.  A copy of the minutes are attached at Appendix B1 (Page 9) for information.

            Supporting information to the Minutes

a)         Report of NHS England and their Assessment of UHL submitted to the Board and updated to reflect the subsequent meeting held with UHL on 16 September 2016 and the revised high level timetable for the consultation and decision making process. Appendix B2 (Page 29)

b)         Letter to the City Council’s Deputy City Mayor from NHS England in response to questions asked at the Health and Wellbeing Board. Appendix B3 (Page 45)

c)         Evidence base for new standards & specifications in relation to the 125 cases per surgeon that was requested by the Health and Wellbeing Board.  Appendix B4 (Page 49)

NHS England were invited to attend the meeting and were originally available to attend but are now unable to send a representative as they are all now required to attend a national oversight meeting for all of specialised commissioning that was subsequently arranged for the same day. They have sent a revised report at Appendix B2 above and have stated that they would welcome the opportunity to attend a future meeting of the Committee.

The Chair commented that this would be the first of a series of meetings to consider NHS England’s proposals for the future provision of congenital heart disease services (CHD) with particular reference to University Hospitals of Leicester NHS Trust.  It was not intended to cover every aspect of the proposals during the meeting; particularly as the process was currently in the pre-consultation engagement stage.  There would be further opportunities at a later date to discuss the issues once the formal consultation process had started.

Members had received the following information prior to the meeting:-

a)     Extracts of decisions taken by Leicester City Council and Leicestershire County Council following the publication of NHS England’s proposals on 8 July 2016.

b)     Rutland County Council’s Health and Wellbeing Board considered the issue at its meeting on 27 September 2016.

c)     Minutes of the City Council’s Health and Wellbeing Board meeting held on 18^th August which received a report from NHS England and a submission from the University Hospitals of Leicester NHS Trust (UHL).  The minutes were supported by the following documents:-

i)       A report of NHS England and their Assessment of UHL submitted to the Board which had been updated to reflect the subsequent meeting held with UHL on 16 September 2016. It also included the revised high level timetable for the consultation and decision making process.

ii)      A letter to the City Council’s Deputy City Mayor from NHS England in response to questions asked at the Health and Wellbeing Board.

iii)     NHS England’s evidence base for new standards & specifications in relation to the 125 cases per surgeon that had been requested by the Health and Wellbeing Board.

NHS England had been invited to attend the meeting and had originally indicated that they were available to attend, however, a national oversight meeting for all of specialised commissioning had subsequently been arranged for the same day as the Joint Committee.  Consequently, NHS England staff involved in the review were now unable to attend or send a representative as they were all required to attend the national oversight meeting. They had, however, submitted a revised report and had stated they would welcome the opportunity to attend a future meeting of the Committee.

Councillor Conde reported that the leader and portfolio holder for health at Rutland County Council had both issued strong statements in support of retaining current CHD services at Glenfield Hospital.

In response to a question relating to the outcomes envisaged for the Joint Committee meeting, the Chair stated that she hoped the Joint Committee would be able to support a strong message to NHS England that, having considered the information supplied to them and also taking into account the views of UHL and the public, the proposals should be abandoned now to avoid wasting any further public funds.  If that was not possible and the consultation process went ahead, then the Joint Committee should agree to meet again; with NHS England representatives present to explain their proposals.

The Chair invited Members for their initial views on the proposals and the following comments were made:-

a)         It was disappointing that NHS England had not attended the meeting

b)         The arbitrary figure of 125 operations per surgeon was not supported by tangible evidence.

c)         Place based planning was a requirement for the development of Sustainability and Transformation Plans but place based planning did not appear to be applied in NHS England’s proposals.

d)         The rationale for sending patients in the region to London and Southampton was questioned not only in relation to the costs to the families involved, but also on the grounds that if NHS England did not support sending patients with the region to the nearest specialist centre then, by default, they were contributing to Glenfield Hospital not hitting the required targets.

e)         UHL’s neonatal services currently provided services to the East Midlands region and the unit’s viability could be jeopardised by the current proposals.

f)          The additional travelling time from Leicester to Birmingham in an emergency was considered to be totally unacceptable.

g)         Patients already travelled from Boston to Leicester for care and this journey would be further exacerbated if services were then transferred to Birmingham.

h)        A number of statements had been made by NHS England in relation to patient choice being the reason for cases of CHD being treated outside of the region and, if this was the case,  Members felt they should be provided with the number of patients and locations involved.

i)          Councils in the East Midlands and East Anglia regions should be contacted to see if they have any evidence that would be helpful in responding to the proposals.

j)          Some scepticism was expressed at the timetable for the review process and whether this allowed for a realistic consideration of the responses to the consultation.  The 12 weeks consultation period would start in December 2016 and end in March 2017. The review of the consultation outcomes would start in April/May 2017.  Letters to NHS Trusts giving them 6 months’ notice of NHS England’s intention to cease commissioning services from them, subject to the consultation outcomes, would be issued on 30 September 2016 with the six months’ notice expiring on 31 March 2017.  The timetable was considered to be cynical and intimidating and suggested the outcomes were predetermined.

k)         The current review appeared to present the same outcomes of the previous Safe and Sustainability Review in 2012, which was successfully challenged through a referral to the Secretary of State.  This had resulted in the Independent Reconfiguration Panel recommending that the Safe and Sustainable Review be abandoned.  Glenfield Hospital was still considered to be delivering excellent outcomes for patients and no concerns had been expressed in recent years about the Hospital’s performance for CHD services.  Members queried what evidence, if any, NHS England had found to suggest that CHD services were not safe and should not be carried out in Leicester.

l)          Glenfield provided an excellent facility and was well placed to serve Lincolnshire, Derbyshire, Nottinghamshire and Northamptonshire.  Removing CHD services from Glenfield would result in the East Midlands being the only region in the country without a Level 1 specialist centre.

m)        Strong concerns were expressed that the announcement had already had a destabilising and unacceptable effect upon Glenfield’s reputation and could affect more people deciding to choose treatment elsewhere in the country; further destabilising Glenfield’s position during the pre-engagement and consultation periods.

n)        MP’s in the region and the extended region under the proposed parliamentary boundary reviews should be encouraged to support the continuation of Level 1 services at Glenfield.

The Chair invited Members of the public to comment on the proposals:-

a)         Karen Chouhan, Chair of Leicester Healthwatch stated that NHS England had confirmed that the consultation process would be conducted on a national basis which did not favour Glenfield Hospital.  Healthwatch in Leicester Leicestershire and Rutland were proposing to organise local consultations on the proposals.

b)         Sally Ruane, Chair of the Leicester Mercury Patient’s Panel felt that the Joint Committee should invite interested parties to submit formal written and oral evidence and to advertise future meetings more widely.

The Chair commented that it had not been intended to involve the public at this first meeting but future meetings would be widely publicised.  She further stated that any referral to the Secretary of State would be supported by robust and detailed evidence.

AGREED:

1)         That the comments made by Members be endorsed.

2)         That a letter be sent on behalf of the Joint Committee to NHS England outlining the Joint Committee’s initial concerns and asking for the proposals to be withdrawn.

3)         A further meeting of the Joint Committee be arranged once the any formal consultation process begins on the proposals and that NHS England be required to be represented at the meeting under Regulation 27 of the Local Authority (Public Health and Wellbeing Boards and Health Scrutiny) Regulations 2013.