The Chair to welcome new members of the Joint Committee and to recap on the Committee’s previous consideration of NHS England’s proposals for Congenital Heart Disease Services.
Background Information
NHS England launched a national consultation on its proposals for the future commissioning of Congenital Heart Disease services on 9 February 2017.
This consultation period was originally intended to end on Monday 5 June, but was subsequently extended to close on Monday 17 July 2017 as a result of the recent Parliamentary Election.
This Joint Committee is the appropriate body to be consulted by NHS England on the proposals in accordance with Regulation 30 of the Local Authority (Public Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. The regulation provides that where the appropriate person (NHS England) has any proposals for a substantial development or variation of a health service in an area they must consult the local authority. Where the consultation affects more than one local authority in an area, the local authorities are required to appoint a Joint Committee to comment upon the proposal and to require a member or employee of the responsible person to attend its meeting and respond to questions in connection with the consultation.
The Regulation does not prevent constituent Councils of the Joint Committee considering the issues separately; but it is the responsibility of the Joint Committee to formally respond to the consultation process.
The Regulations also provide that a Council may refer a proposal to the Secretary of State where:-
• it not satisfied that the consultation has been adequate in relation to content or time;
• it is not satisfied with the reasons given for the change in services; or
• it is not satisfied that that the proposal would be in the interests of the health service in its area.
This referral must be made by the full Council unless the Council has delegated the function to a Committee of the Council. Currently, only the City Council had delegated the powers to refer the NHS proposals to the Secretary of State. Leicestershire County Council and Rutland County Council would need to approve any referral at their respective Council meetings.
Supporting Information
The Joint Committee first met on 29 September 2016 and received the following supporting documents:-
· NHS England’s proposals published on 8 July 2016.
· Extracts of decisions taken by Leicester City Council and Leicestershire County Council’s Cabinet in response to NHS England’s proposals.
· A report from NHS England and a submission from the University Hospitals of Leicester NHS Trust (UHL) submitted to the City Council’s Health and Wellbeing Board at their meeting on 18 August 2016, together with the Minutes of the Meeting.
· 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.
· A letter to the City Council’s Deputy City Mayor from NHS England in response to questions asked at the Health and Wellbeing Board.
· Evidence base for new standards & specifications in relation to the 125 cases per surgeon that was requested by the Health and Wellbeing Board.
The second meeting on 14 March 2017 received the following documents:-
· The “Proposals to Implement Standards for Congenital Heart Disease Services for Children and Adults in England - Consultation Document”
· Minutes of the Meeting of the Joint Committee held on 29 September 2016 when the Joint Committee considered the proposals in the pre-consultation engagement stage.
· A letter from Will Huxter responding to issues raised by the Joint Committee on 29 September 2017.
· Proposals to implement standards for Congenital Heart Disease Services for Children and Adults in England - Consultation Summary.
· Congenital Heart Disease Equality and Health Inequalities Analysis – Draft for consultation.
· Congenital Heart Disease Provider Impact Assessment: National Panel Report.
· NHS England Congenital Heart Disease Provider Impact Assessment.
· Congenital Heart Disease Consultation – Events List.
The agenda, reports and minutes of the Joint Committee’s meetings referred to above can be found at the following link:-
http://www.cabinet.leicester.gov.uk/ieListMeetings.aspx?CId=420&Year=0
Minutes:
The Chair stated that given there were a number of new members on the Committee and the Programme Director for the CHD was attending his first meeting of the Committee; she felt it would be useful to set the scene and recap on the points raised at the previous meeting of the Committee.
The Chair mentioned the following points:-
NHS England stated that it wasn’t for them to mandate to patients where to have surgery at a particular centre and that it was for parents/patients to determine where they wished to receive treatment.
· UHL disputed this stating that it was NHS England’s responsibility to organise these services and whilst they did not choose where a patient was treated, these proposals were seeking to determine where they would not be treated.
The outstanding issue with regards to Glenfield hospital’s plans from NHS England’s perspective related to their ability to reach 375 operations (125 each for 3 surgeons) per year.
· UHL also argued that small adjustments to the catchment area would enable them to meet the required number of operations.
· Members commented that the destabilising effect of the ongoing proposals may also be having a negative effect and would no doubt influence patient choice if they thought the centre may close whilst not realising the high quality of care that they would receive.
· There was anecdotal evidence that people in Northampton were being directed further south when Glenfield was a much closer option.
It was debated as to whether the figure of 125 surgeries had been applied fairly across all CHD sites in the consultation proposals; given that Newcastle, in particular, had been given no time frame within which to reach the standards.
· UHL argued that if it was safe for Newcastle to continue providing Level 1 services whilst providing considerably less surgeries than Glenfield; then why should it be unsustainable for Glenfield to continue with higher levels of surgeries and still also provide the National ECMO service.
· NHS England stated they would revisit Newcastle if they couldn’t meet the required number of surgeries in an agreed timeframe; although no timeframe had been agreed. Also, Newcastle were being treated separately, as they also undertook heart transplant services, the only centre to do so one outside of Great Ormond Street Hospital to perform them and it would be unsafe to only have that service on one site.
· Committee members argued that given the 125 surgeries was not backed by any real scientific evidence for it to be an absolute criteria to provide a resilient service and, given that Newcastle were being given an indefinite time period to meet the required number of surgeries, Leicester should also been given extra time. If, like Newcastle, they subsequently didn’t meet the required number of surgeries in an equal timeframe, then NHS England should review the situation at that time.
· UHL’s CHD unit was rated as ‘outstanding’ by the CQC; the only one in the country and this should not go unrecognised.
· Also, the fact that there were 200 standards, and some were being weighted more than others, felt arbitrary to committee members and they seemed to be chosen to help push a pre-determined decision. The fact that the standards were being implied retrospectively rather than from their approval date in July 2015 was also questioned.
NHS England’s proposal would result in an entire region not having CHD surgical services. This would be the only region not to have them and would leave a large geographical gap across the country.
· NHS England suggested that Glenfield could perform Level 2 services as part of the proposals which would still offer a service in the East Midlands
· UHL questioned whether they would be able to perform Level 2 services without a Level 1 service, as they would not have cardiac anaesthetists on site without a Level 1 service and currently no model of what a Level 2 service would look like existed.
The Committee also raised the issue of travel times not being considered properly and the burdens of travel on families seemed nonsensical given there was a service in the East Midlands already providing good outcomes.
The Committee had also been advised of the following prior to the meeting:-
Background Information
NHS England had launched a national consultation on its proposals for the future commissioning of Congenital Heart Disease services on 9 February 2017.
This consultation period was originally intended to end on Monday 5 June, but was subsequently extended to close on Monday 17 July 2017 as a result of the recent Parliamentary Election.
This Joint Committee was the appropriate body to be consulted by NHS England on the proposals in accordance with Regulation 30 of the Local Authority (Public Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. The regulation provided that where the appropriate person (NHS England) had any proposals for a substantial development or variation of a health service in an area they must consult the local authority. Where the consultation affected more than one local authority in an area, the local authorities were required to appoint a Joint Committee to comment upon the proposal and to require a member or employee of the responsible person to attend its meeting and respond to questions in connection with the consultation.
The Regulation did not prevent constituent Councils of the Joint Committee considering the issues separately; but it was the responsibility of the Joint Committee to formally respond to the consultation process.
The Regulations also provided that a Council may refer a proposal to the Secretary of State where:-
• it was not satisfied that the consultation has been adequate in relation to content or time;
• it was not satisfied with the reasons given for the change in services; or
• it was not satisfied that that the proposal would be in the interests of the health service in its area.
This referral must be made by the full Council unless the Council has delegated the function to a Committee of the Council. Currently, only the City Council had delegated the powers to refer the NHS proposals to the Secretary of State. Leicestershire County Council and Rutland County Council would need to approve any referral at their respective Council meetings.
Supporting Information
The Joint Committee had first met on 29 September 2016 and received the following supporting documents:-
· NHS England’s proposals published on 8 July 2016.
· Extracts of decisions taken by Leicester City Council and Leicestershire County Council’s Cabinet in response to NHS England’s proposals.
· A report from NHS England and a submission from the University Hospitals of Leicester NHS Trust (UHL) submitted to the City Council’s Health and Wellbeing Board at their meeting on 18 August 2016, together with the Minutes of the Meeting.
· 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.
· A letter to the City Council’s Deputy City Mayor from NHS England in response to questions asked at the Health and Wellbeing Board.
· Evidence base for new standards & specifications in relation to the 125 cases per surgeon that was requested by the Health and Wellbeing Board.
The second meeting on 14 March 2017 had received the following documents:-
· The “Proposals to Implement Standards for Congenital Heart Disease Services for Children and Adults in England - Consultation Document”
· Minutes of the Meeting of the Joint Committee held on 29 September 2016 when the Joint Committee considered the proposals in the pre-consultation engagement stage.
· A letter from Will Huxter responding to issues raised by the Joint Committee on 29 September 2017.
· Proposals to implement standards for Congenital Heart Disease Services for Children and Adults in England - Consultation Summary.
· Congenital Heart Disease Equality and Health Inequalities Analysis – Draft for consultation.
· Congenital Heart Disease Provider Impact Assessment: National Panel Report.
· NHS England Congenital Heart Disease Provider Impact Assessment.
· Congenital Heart Disease Consultation – Events List.
The agenda, reports and minutes of the Joint Committee’s meetings referred to above can be found at the following link:-
http://www.cabinet.leicester.gov.uk/ieListMeetings.aspx?CId=420&Year=0