Appendix 1

AGENDA ITEM NO. 6(j)

REPORT TO: Social Care and Health Policy & Performance Board

DATE: 20th January 2004

REPORTING OFFICER: Executive Director Social Care, Housing and Health

SUBJECT: Scrutiny of Proposed Changes in Clinical ServicesNorth Cheshire Hospitals NHS Trust

WARD(S): Borough-wide

1.0 PURPOSE OF REPORT

1.1 To provide members with details of changes to Clinical Services being proposed by North Cheshire Hospitals NHS Trust (appendix 1)

1.2 To provide details of how the proposals have been scrutinised so far (Appendix 2)

1.3 To recommend actions required for the next stages of the scrutiny process, prior to the trusts implementation of any changes (Appendix 2, paragraph 6)

2.0 RECOMMENDED: That

(1) this initial report be noted, comments made and incorporated into a final report to PPB once further requirements have been satisfied; and

(2) the recommendations and actions set down in Paragraph 6 of Appendix 2 be noted as appropriate action to be taken forward by the North Cheshire & Halton PCT Trust Boards and progress reported to a future PPB.

3.0 BACKGROUND INFORMATION

3.1 On 6th November 2003, the Board of North Cheshire Hospitals NHS Trust approved proposals to reconfigure Clinical Services. These proposed changes affect both Halton and Warrington Hospitals. Details are provided in the paper “Clinical Services Review – A Roadmap for our Hospitals Future” presented to the Trust Board – Appendix 1.

3.2 The reconfiguration proposed constitutes a substantial change to services. Accordingly, on 11th November, the Social Care and Health PPB agreed a process

for scrutiny of the matter.

3.3 The proposals build on work previously undertaken during 2002 and reported in the Trusts document “A Vision for Future Changes”.

3.4 The Chairman, Chief Executives of the North Cheshire Hospitals and Halton PCT Trust have been invited to attend the meeting of Policy & Performance Board on 20.01.04. This will allow members of PPB to seek further clarification of points and to hear from the senior team, their response to the issues raised by the initial Scrutiny Process.

4.0 SCRUTINY PROCESS AND ISSUES

4.1 A scrutiny panel, established under the Chairmanship of Cllr T McInerney has examined the proposals for change. Full details of the process, findings and recommendations are set down in Appendix 2.

4.2 Whilst recognising that the proposed changes affect both Halton and Warrington Hospitals, the greatest impact is upon the residents of Halton.

4.3 The proposal that all emergency surgery be transferred to Warrington warranted particular attention.

4.4 Whilst not a part of the proposed changes, the provision of the two intensive care beds at Halton, has a central bearing on hospital services, both now and in the future. This issue has therefore been fully examined.

4.5 It will be essential that the Board of the NHS Trust set down their clear vision for the development of Halton Hospital Campus. This as a key part of continuing acute and medical services.

5.0 POLICY IMPLICATION

5.1 The direct impact of these proposals is upon Hospital Services. However, they have considerable consequences for the health and wellbeing of all people living in the Borough. Health remains the top priority of the Borough Council. Therefore it is essential that local services address the specific needs of the population and that access to Hospital Services is not compromised.

5.2 The proposed changes are likely to have specific impact upon Social Care Services. It is therefore essential that as details are developed, they address requirements across the “whole system”.

5.3 People in Halton rely heavily on public transport, therefore the transport implications of the proposed changes require further exploration.

6.0 BACKGROUND PAPERS

6.1 “A Vision for future Services” – North Cheshire Hospitals NHS Trust 2002 – Available Grosvenor House, John Webb.

Appendix 1

Clinical Services Review

A Road Map for our Hospitals’ Future

Background

The purpose of this document is to set out a clear direction for the development of clinical services at Halton and Warrington Hospitals. More specifically it aims to achieve three things:

1. Make clear our view of which services should be provided from the Warrington and Halton Hospital sites;

2. Inform people of what has happened to the suggestions made in the Trust’s 2002 document ‘A Vision for Future Services’;

3. Outline some changes that we wish to make to the delivery of surgical services in order to further improve patient care.

The ‘ Vision for Future Services’ Document

A discussion document; 'A Vision for Future Services', was drawn up in late 2002 in response to the NHS Plan. The document outlined both the Trust’s vision for care and a large number of proposals for change in the way in which some health services might in future be delivered at Warrington and Halton Hospitals.

The document was widely circulated to hospital, health and social care staff as well as patient and public representatives throughout North Cheshire in order to canvass their views. It was also formally presented to local authority Overview and Scrutiny Committees (OSCs) in Warrington and Halton.

The ‘Vision for Future Services’ made clear the Trust Board’s expectations in a number of key areas. These were that:

“By 2008 the hospital services serving the residents of North Cheshire will be amongst the best in the UK.

Halton and Warrington Hospitals will be fully integrated yet will play their unique role in delivering health benefits to local people.

…, both hospitals will provide the range of specialties that they do today. This means that local residents will be referred to their local hospital for a consultant opinion on their illness or condition…”

These statements remain valid today and have strongly influenced the Trust’s thinking.

Progress Since 2002

In the fast-changing environment that is the modern NHS, much has inevitably happened since the ‘Vision for Future Services’ document was issued. Major changes include the launching of the national policy on choice under which patients will increasingly select the hospital of their choice, an increased national commitment to keep services local wherever clinically feasible and an increased national focus on ensuring that hospitals’ ability to treat patients is maximised through best use of their clinical capacity.

These changes, together with the views of a large number of clinicians and local stakeholders, have led us to modify and further develop the proposals and suggestions contained within the ‘Vision for Future Services’ paper – in some cases quite radically.

Since the ‘Vision for Future Services’ was issued, there has been very extensive discussion about its contents. It is both my view and that of our front-line staff that the time is now right to bring the discussion phase of our work to an end and move to decision-making and then implementation.

Current and Proposed Service Profile in North Cheshire Hospitals NHS Trust

The box below illustrates the location of services across the Trust’s two hospitals:

Service Warrington Site Halton SiteChild Health Y NCritical Care Y YEmergency Care Y YMaternity Y N *Medicine and Elderly Care Y YOutpatients Y YPathology Y YPharmacy Y YRadiology Y YGeneral Surgery Y YTherapies Y YTrauma & Orthopaedics Y YWomen’s Health Y N(* Some Maternity outpatient services at Halton)

The Trust is not proposing a major reorganisation of services. We are intending to keep the current disposition of specialties at both hospitals in order to remain able to deliver care as close to our patients as possible.

We are also not proposing widespread change at the sub-specialty level. With the exception of surgical services (which are discussed below and where we believe that by making some changes we can treat patients better), we are not proposing significant changes to the location of services.

Appended to this paper are two documents:

A position statement that describes where we are in relation to the specific proposals for service development that were included within the ‘Vision for Future Services’ document. Many of these developments have already been implemented to the benefit of patients (eg improvements to the Minor Injuries Unit at Halton General hospital) while others remain aspirations of the Trust but are dependent upon either the decisions of external NHS bodies or on external funding (eg the proposed development of additional renal dialysis stations).

A service profile by Directorate. This describes the services provided at both of our hospitals in greater detail than the above table. In so doing it makes clear our commitment to preserving the current broad disposition of services (with the exception of the proposed changes to surgical services).

Reconfiguring Surgical Services

As mentioned above, the one area where we believe that significant benefits for patient care would be generated from changing elements of the current service model is within surgical services.

These proposals, which have been generated by the Trust’s surgeons at both Warrington and Halton Hospitals, would see a significant increase in elective surgery on the Halton General Hospital site coupled with a centralisation of surgical emergencies onto the Warrington Hospital site.

In order to treat patients ever more quickly, it is essential that hospitals make the fullest use of their bed, theatre and staff capacity. To date, the Trust has not fully utilised the capacity of Halton General Hospital. It is therefore proposed that a wider range and number of elective surgical procedures will in future be undertaken at Halton. This would include a range of upper gastro-intestinal, colorectal, vascular, breast and urology procedures. It is anticipated that 75 additional patients will be treated each week at Halton General Hospital once these changes come into full effect.

This additional work at Halton General Hospital will allow the Trust to not only treat patients more quickly but will also enable us to offer more Runcorn and Widnes patients the ability to have their surgery at their local hospital as opposed to having to travel to Warrington as they do now.

It will in no way compromise the right of Warrington patients to be treated in their local hospital (as the same surgery will remain available at Warrington). It will however allow the Trust to offer some Warrington patients the choice of being treated at Halton should they so wish. Patients will not be compelled to move between sites to receive their elective surgery under this initiative.

Surgical emergencies are currently managed on both the Warrington and Halton Hospital sites. However the vast bulk of such cases are already managed at Warrington with Halton General Hospital only ever having dealt with a very small number of surgical emergency patients. The Trust’s surgeons believe strongly that the four or five surgical emergencies per day that are currently seen at Halton could be better managed by a single dedicated emergency surgical team operating at Warrington Hospital.

The benefits of the proposed surgical changes for patients would include:

fewer planned operations cancelled because of pressure from emergency surgery and a lack of availability of beds

reduction in waiting times for surgery

increased opportunities for patients to book their operations in advance

a wider range of consultant sessions on the Halton General site

an opportunity for more patients to receive their operations at their most local NHS hospital

shorter stays in hospital

all emergency surgical patients would be seen by a consultant daily.

The benefits for staff and our Trust would include:

security and reassurance for staff at both hospitals about the future direction of services

the ability to achieve targets for day case surgery and access times for inpatients and outpatients

increased volume of people being treated at Halton Hospital

surgeons currently based at Warrington would have sessions (theatre, endoscopy, out-patients) on both sites.

considerable reduction in waiting list costs and pressures

the ability to make the best use of Halton General Hospital and in particular, the High Dependency Unit (HDU) and provide a critical care facility for the whole of North Cheshire

all surgical emergencies managed on one site with full team cover

reduced costs for locum cover for surgeons

the ability to draw up an integrated rota for junior doctors to complywith the European Working Time Directive (EWTD) and New Deal requirements

enhanced opportunities for emergency surgical training and more attractive job plans for new consultants, leading to improvements in recruitment and retention.

These proposed changes to emergency surgical services will not affect the Minor Injuries Unit at Halton General Hospital. This will continue to care for the same mix of patients as now.

Intensive Care at Halton General Hospital

Neither the Trust’s statement of its clinical direction nor the proposed changes to surgical services are dependent upon the status of the two Intensive Care beds at Halton General Hospital. Nonetheless the future status of these beds is very understandably a matter of considerable concern to both staff and the public.

Critical care at Halton General Hospital is delivered through high dependency beds, which everyone agrees must be maintained, and two intensive care beds. High dependency beds provide the correct level of clinical support for the critical care requirements associated with the vast majority of elective surgery conducted at Halton. Intensive care beds provide the highest level of care for patients suffering multi-system failure.

The latter beds are temporarily closed owing to a difference in professional opinion regarding the level of anaesthetist cover required to safely maintain them. The Trust has made clear its intent to reopen the ITU beds at Halton

General Hospital but requires clear direction on the clinical safety issues prior to being able to move ahead with this.

The Trust has therefore expressly invited the Commission for Health Improvement (CHI- the national NHS inspectorate) to provide a definitive ruling on whether or not the beds at Halton can be run safely using a proposed model of joint cover between Consultant Anaesthetists and Intensivists.

Communicating and implementing our proposals

I am committed to full, open and proactive communication about our proposals for change. Following the discussion at the Trust Board, we will continue to discuss our proposals with key stakeholders including the Oversight and Scrutiny functions of our two Local Authorities.

Following this, we will be looking to implement the surgical services changes at the earliest opportunity.

Conclusion

Change within the modern NHS will continue apace and will demand that we keep our services under continual review. It is therefore neither sensible nor possible to rule out changes to our services for all time.

Notwithstanding this reality, I want to be clear to staff, patients and local people about the clinical direction of this Trust. This paper makes clear the Trust Board’s commitment to continue to deliver services at both Warrington and Halton Hospitals in order that local people can wherever possible be treated at their local hospital. In the few areas in which we are proposing immediate changes we believe that this can be strongly justified in terms of the clinical benefits that it will deliver to local people.

Ian DaltonChief Executive31st October 2003

APPENDIX A

Clinical Services Review Position Summary

Increasing Hospital Capacity

(1.) Ensure Sufficient Outpatient, day case, inpatient and diagnostic capacity to deliver NHS Plan targets

North Cheshire Hospitals is a national pilot site for the Improvement Partnership for Hospitals (IPH) programme which is aimed at achieving better care without unnecessary delays along whole patient pathways focussing on the below criteria and on promoting organisational and leadership development at all levels

o Theatreso Outpatientso Diagnosticso Elective Pathwayso Emergency Pathwayso Transfer / Rehabilitation and Dischargeo Choice

This major service development initiative will ensure that the Trust uses its clinical capacity optimally. By achieving this, we aim to become amongst the very best run hospitals in the NHS.

(1.1) Increase number of patients receiving their care as a day case

North Cheshire Hospitals is currently being supported by the Modernisation Agency in a development programme for increasing the number of elective procedures performed as a day case. We are aiming to deliver national best practise levels of day case surgery as a result of this work.

There is a dedicated day case unit for surgery at Halton Hospital and dedicated day case beds at Warrington Hospital for women’s services, orthopaedics and ophthalmology.

Plans have been agreed for the development of an extension to the scope room at Halton Hospital that will consist of 3 beds and 8 specialist chairs. The expected start date is January 2004 with a completion date in April/May 2004. This will enable the transfer of endoscopy work currently undertaken in theatres in Halton Hospital releasing capacity for an increase in day surgery.

(1.2) Develop sufficient bed numbers to deal with growing demand in Medicine and Elderly Care

Previous analysis of our capacity needs identified the need for additional beds across the health economy including community nursing and intermediate care provision. This now needs revisiting with a more rigorous analysis of throughput as part of the Improvement Programme for Hospitals. This more detailed work will also examine alternative models to hospital admission and will lead to a clear understanding of our capacity needs.

Developments in transitional care include intermediate care beds in Chestnut House in Appleton and the Warrington Primary Care Trust is aiming to develop further intermediate care beds in conjunction with a private provider. In Halton, the Evercare model is being piloted which is preventing unnecessary admission to acute care and there has been an increase of 6 intermediate care beds in Widnes, 6 in Runcorn and a further 5 nursing beds in Widnes.

(1.3) Expand consultant and other clinical services to meet current demands for care

Since 2001 14 new consultants have been appointed to the Trust in Anaesthetics, Histopathology, A&E, Radiology, Urology, Trauma and Orthopaedics and Cardiology.

A further Breast Surgeon to be appointed next year The Trust is committed to the development of vascular surgery

across the local health economy and is very actively seeking funding for a further consultant appointment. This will secure the future provision of emergency vascular services to provide local and accessible care and treatment for populations in North Cheshire and St Helens and Knowsley.

The consultant surgeons rota will be expanded to a full complement pending the permanent appointment of two associate specialists

Extensive work in recruitment and retention strategies across all Clinical professional groups being undertaken, along with workforce redesign and creation of new roles to meet future demands..

(1.4) Put in place arrangements to protect inpatient capacity from the impact of emergency admissions

All complex Adult ENT and all Children’s surgery is carried out at Warrington Hospital

The proposal to reconfigure Surgical Services across the two Hospital sites by increasing the variety and volume of elective surgery carried out at Halton and consolidating emergency surgery

at Warrington Hospital offers the most significant development in surgery in North Cheshire. It will allow capacity for elective surgical care to be protected from the demands of emergency cases. This will allow waiting times to be shortened and the number of patients whose operation has to be cancelled to be reduced.

(1.5) Genito-Urinary Medical (GUM) Services The Commission for Health Improvement has recommended that changes should be made to the accommodation GUM services at Warrington Hospital are delivered in order to enhance patient confidentiality. This is the subject of an accommodation review and the Trust is committed to addressing this issue as a matter of urgency.

There has been expansion of community based services to address increased demand resulting from an outbreak of bacteria resistant gonorrhoea

Reforming Emergency Care

(2.) Provide high quality timely diagnosis, treatment and where necessary, admission to hospital for unscheduled patients / Provide range of alternative points of access for patients and referring GPs / Address recommendations of CHI Review 2002 for adequate facilities in A&E Department

A multi-million pound development of the A&E Department at Warrington is now underway. Once completed, this will radically improve patient care. The scheme is scheduled for completion in Spring 2004

Following a recommendation from the Commission for Health Improvement, protocols are in place with local G.P.s and the ambulance service in Halton to ensure managed medical emergencies can be admitted safely.

Ward A1 at Halton has been developed with medical and surgical admissions facilities for same day/ next day rapid access to clinics for urgent G.P. referral for consultant opinion. The facility is also providing rapid treatment and diagnosis, so preventing inpatient episodes, example patients requiring Deep Vein Thrombosis treatment or blood transfusion

A major refurbishment of the Minor Injuries Unit at Halton General Hospital is now under way and completion is scheduled for August 2004.

Physician of the day/week remains the optimum model for providing effective care and facilitating appropriate discharge of patients and is required at Halton and Warrington Hospitals. Work is ongoing within the Medical Directorate to progress this within the constraints of the European Working Time Directive (EWTD) and the existing establishment of consultants.

Protocols in place with Mersey Regional Ambulance Service for direct referral arrangements to Coronary Care Unit at Halton for myocardial infarction (heart attack) patients

Reforming Emergency Care

(2.) Provide high quality timely diagnosis, treatment and where necessary, admission to hospital for unscheduled patients / Provide range of alternative points of access for patients and referring GPs / Address recommendations of CHI Review 2002 for adequate facilities in A&E Department

(Continued)

A significant element of the proposal to reconfigure surgical services across North Cheshire is to consolidate emergency surgery on the Warrington site. This would allow all surgical emergencies to be managed on the one site with full team cover, patients would be reviewed daily by a consultant thereby reducing the length of stay; there would be a concentration of emergency surgical training opportunities; locum costs for consultant surgeons would be virtually nil, and the change in management of emergency surgical patients from Halton (approximately 4 per day) would allow the consideration of an integrated junior rota which would assist toward New Deal / EWTD requirements

The ongoing redesign of emergency access in line with national NHS best practise is well underway at both sites. Patients are streamed on arrival to the A&E / MIU (Minor Injury Unit) Departments allowing immediate assessment, treatment and diagnosis of emergency patients, and ensuring that the patient’s journey through emergency care takes a maximum of four hours only. In line with national NHS expectations, this is currently achieved for 90% of all patients attending. Our goal is to further increase this to 100% by December 2004, and to further reduce the median to 3hrs.

Partnership working with Warrington P.C.T to provide Out of Hours services in a newly created primary care centre within the A&E development has produced an integrated model of care. This will offer patients a single point of access for emergency care. Discussions are taking place to develop a similar model at the Halton site.

(3.). Develop Specialist Services

Develop number of beds for renal dialysis to match projected needs

Local Primary Care Trusts are currently conducting a major review of renal services. This will lead to a 5 year strategy for the development of renal services including haemodialysis across Cheshire and Merseyside. This will direct the number and location of additional renal dialysis stations within our hospitals. As a Trust we are committed to developing further renal dialysis stations and we will feed the views of our clinicians into this regional review. The findings and recommendations of the review are expected in Spring 2004.

Augment diabetes, respiratory illness and stroke services 6 acute assessment stroke beds with manual monitoring equipment have been placed in Ward A1 at Halton bringing the total stroke bed complement to 6 assessment and 21 rehabilitation beds at Halton General Hospital.

6 acute assessment stroke beds with automatic monitoring equipment have been developed on B14 at Warrington providing a total stroke bed complement of 24 assessment and 24 rehabilitation beds.

The Trust recognises the need for the development of integrated diabetic services in both Warrington at Halton. We will work with our Primary Care Trusts to bring forward proposals on how the service should work and how it can be funded.

The respiratory service has been redesigned to provide increased support for respiratory and lung cancer services with additional specialist consultant sessions. Work is underway to develop non-invasive ventilation within the respiratory ward at Warrington and a nurse led admission service at Halton for 6 beds.

Expand and Develop he Clinical and non-clinical workforce to meet demands for services.

North Cheshire Hospitals Trust is currently developing a Workforce Plan to;

1. Meet the demands placed upon services over forthcoming years

2. Accommodate changes in availability of clinical and non-clinical staff with the introduction of the European Working Time Directive (EWTD)

A costed action plan is to be agreed and submitted to the Cheshire and Merseyside Strategic Health Authority in December 2003.

APPENDIX BNorth Cheshire Hospitals NHS Trust Service Profile

CHILD HEALTH Children’s services are located on the Warrington site providing inpatient and outpatient care to babies and children from the North Cheshire area.

NEONATAL SERVICE Babies are accepted into a purpose built neonatal unit from 26 weeks of age/ 700gm birth weight. The unit has 20 cots and provision for 3 intensive care cots. A team of community neonatal nurses provides an outreach service for discharged oxygen dependant babies.

CHILDRENS SERVICE Children are cared for in an integrated medical and surgical paediatric unit. In addition to the general paediatric beds there are cubicles for children with infectious disease or serious illness plus one that is equipped and staffed for high dependency treatment and care.

Outpatient services are held in a purpose built department, which is separate from adult services. Visiting consultants provide outpatient services for;

Cardiology, urology, rheumatology, ophthalmology, dermatology, cystic fibrosis, specialist paediatric surgery, general surgery and visual stimulation.

Specialist nursing teams provide outreach nursing services in the community to children with diabetes, epilepsy, and respiratory care and continuing care.

CRITICAL CARE SERVICE DIRECTORY Critical Care is the directorate that provides the following services Anaesthetics – provided on both hospital sites Intensive care and high dependency care- provided on both

hospital sites Coronary Care Nursing – provided at Halton Theatre Services – provided at both hospital sites Sterile Services – provided at both hospital sites Acute Pain Management – provided at both hospital sites Chronic Pain Management – provided at both hospital sites Endoscopy – provided at both hospital sites

ACCIDENT AND EMERGENCY CARE/MINOR INJURIES Emergency care is provided to Warrington, Halton and surrounding areas with a full 24 hour service at the Warrington site. The Halton site provides Minor Injury care between the hours of 09.00 and 23.00 each day of the week of a medical or surgical nature.

Streaming of patients, has taken place at both sites with the three streams at the Warrington site being Minors, Majors and Paediatrics. The two streams at the Halton site are adult minor injuries and paediatric minor injuries.

Nurse Practitioners work across both sites and the services of a Nurse clinician are now available at the Warrington site and this will be extended to the Halton site in the near future.

There is a short stay unit that is presently incorporated within Acute Admissions Unit due to the refurbishment of the department. By summer 2004 there will be an 11 bedded Short Stay Unit within the Accident and Emergency Department where patients will be cared for on a short-term basis avoiding admission to an in-patient bed.

WOMEN’S HEALTH

Maternity Maternity services for the population of Warrington, the majority of Halton and women who chose to deliver at Warrington but live in other areas, are based on the Warrington site.

The maternity services are provided in a dedicated unit that was opened in 1994 offering modern and well equipped facilities where the multi-disciplinary team is focused on effective team working to provide excellent women-centred care.

Hospital midwives provide midwife antenatal bookings. Community midwives provide home registration to the majority of pregnant women in Warrington.

All obstetricians provide routine antenatal care. All women have a named community midwife and we offer midwifery led care to low risk pregnancies. High risk pregnancies also benefit from a community midwife and hospital support.

Parentcraft education is offered on site and in the community. We provide a drug/alcohol liaison midwife and support for teenage pregnancies with midwife input.

We offer a midwifery led smoking cessation service. We have recently appointed a Surestart midwife for the West area of Warrington.

In July 2003 the Antenatal Day Unit opened, with dedicated on site scanning facilities. The aim of this unit is to allow pregnant women to remain at home with their partner and families, where possible this unit will allow us to monitor high risk patients effectively and allows midwives, obstetricians and ultrasonographers to work as a team. It will also reduce admissions to the delivery suite of women who are not in labour.

GYNAECOLOGY

Warrington Gynaecology inpatient services are provided in a dedicated ward treating both emergency and elective patients whilst women undergoing day case surgery are treated in a specialist women’s day case centre.

Outpatient facilities are provided in the separate women’s specific outpatient department.

There is a Senior Nurse Practitioner working and managing the Women’s Day Care Centre who leads on supervision of all nurse led clinics within the centre.

GYNAECOLOGY

Halton The service within the Halton site is provided as a visiting service from Countess of Chester Hospital and St Helens & Knowsley NHS Trust.

At Halton, outpatient and day case care is provided with those patients requiring inpatient stay being treated at the respective consultants home hospital i.e. Countess of Chester and Whiston.

MEDICINE AND ELDERLY CARE Medicine and elderly care is provided at both Warrington and Halton. Warrington provides specialist Respiratory, Diabetology, Cardiology, Gastroenterology and Elderly Care treatment as well as general medicine. All of these specialities are supported by Outpatient Clinics.

Halton has 6 wards providing the same range of in patient specialities and has access to 2 Coronary Care Unit beds in the Critical Care Unit.

Genito-Urinary Medicine and Dermatology are provided as outpatient services on both sites, and Dermatology has links with the Royal Liverpool for inpatient care. There is a day care treatment centre on the Warrington site.

Specialist Nurses are employed in Respiratory, Rheumatology, Gastroenterology, Cardiology and Diabetology and form an integral part of these services.

A Stroke Care Co-ordinator and Tissue Viability Nurse are also employed to support the medical directorate. Rheumatology is incorporated into Medicine on the Halton site, but is part of the Orthopaedic Directorate at Warrington

Cardiology and Respiratory are supported by the Echocardiogram Services Department which is again provided on both sites.

OUTPATIENTS Outpatient Departments are located at both Halton and Warrington hospitals. The total number of outpatients seen during April 2000 to March 2001 at Warrington 185,418, at Halton 66,419.

Clinics are held on both sites and usually during Monday – Friday 8.30 am to 5.00 pm.

Satellite clinics are also held on both sites from Clatterbridge Hospital Oncology, Walton Hospital Neurology.

Satellite clinics are also held at Warrington from the Whiston Hospital Department of Plastic Surgery.

In addition to the specialty clinics, both hospital sites provide;Ear dressings serviceAudiology serviceNurse led clinicsPhlebotomy serviceOncology clinics

Site specific outpatient facilities are; Halton Hospital:

Cancer Information resource centre Warrington Hospital:Dermatology Day centre – Treatment area for certain dermatology conditions.

PATHOLOGY Pathology is a multidisciplinary diagnostic Directorate providing Haematology, Biochemistry, Microbiology and Histopathology to both hospital sites.

Approximately fifty per cent of work is generated in Primary Care and work is continuing to improve the availability of service to Primary Care.

The major pathology site is on the Warrington site with satellite facilities at Halton Hospital.

Scientific staff attend and help run the H pylori clinic, GTT clinic, anticoagulant clinic and Breast Clinics together with outreach anticoagulant clinics at Castlefields Medical Centre.

PHARMACY The department provides pharmaceutical services at Warrington and Halton General Hospitals and a satellite pharmacy in the mental illness unit at Hollins Park, which is part of The 5 Boroughs Partnership. The Warrington pharmacy moved to a new building in April 2000. It also has service level agreements with the Halton, Warrington, Cheshire West, Ellesmere Port & Neston PCTs for support to their community- based services and for support to Halton Haven hospice in Halton and St Rocco’s Hospice in Warrington. Services are also provided to the Brooker Centre and associated units of the 5 Boroughs Partnership in Halton under a service level agreement

RADIOLOGY Radiology is located on both hospital sites with an additional satellite A&E X-ray department at Warrington and the local Breast Screening service, which covers Warrington, Halton, Whiston and St Helens.

Both hospital sites have CT units, Ultrasound departments and the Specialist imaging suites. Warrington also has the Nuclear Medicine department. These provide a diagnostic and therapeutic imaging service, x-ray film storage and retrieval and radiological advice to the clinicians of the Trust and the PCT’s.

Magnetic Resonance Imaging is available on the Warrington Hospital site.

The A&E X-ray department at Warrington is open 24 hours per day, 365 days per year for non-routine, urgent examinations. Both Halton and Warrington x-ray departments are staffed until 9pm each day but only deal with non-routine work after 5pm and at weekends. The core hours of the departments are 9am to 5 pm, Monday to Friday. There is limited GP patient access outside the core hours. The remainder of the service is supported by an on call arrangement staffed by radiologists and radiographers.

SURGICAL SERVICES The Surgical Directorate comprises General Surgery and its related sub-specialties; Urology, Ophthalmology, ENT, Orthodontics and Oral/Maxillofacial surgery.

Both hospital sites currently provide emergency, elective and outpatient treatment for surgical and urological patients. Treatment of ophthalmic and ENT emergencies are only provided at the Warrington site but elective and outpatient treatment for these specialties and orthodontics and oral surgery are provided on both the sites.

Proposals for significant reconfiguration to surgical services in North Cheshire are referred to in the main body of this document (pages 3-5).

THERAPIES The following services are provided across the two sites: Musculoskeletal Orthopaedics Rheumatology Rehabilitation (stroke, neurological, elderly, surgery, amputees and

input into Rapid Response services) Cardiac Rehabilitation Respiratory (including input into Rapid Response Respiratory) Hydrotherapy Speech Therapy for Dysphagia and voice problems Nutrition and Dietetics for Diabetes, Health Promotion, Nutrition

Support and general dietetic advice Paediatrics Women's health Community physiotherapy/Occupational Therapy and Speech and

Language Therapy Services are provided on an in-patient and out-patient basis. Our

patient services are delivered in a variety of settings, which include Hospital outpatients, Community Clinics, GP Practices and peoples own homes. As part of Intermediate Care we also deliver a service to Padgate House and Hawthornes.

TRAUMA AND ORTHOPAEDICS Trauma and Orthopaedic adult and paediatric services are provided in the main at Warrington with day case only at Halton.

Emergency care is provided in two orthopaedic wards incorporating a trauma admissions unit and orthopaedic rehabilitation beds. Elective care is provided in a dedicated elective orthopaedic unit, which also includes pre-operative assessment and physiotherapy services.

Appendix 2

NORTH CHESHIRE HOSPITALS NHS TRUST RECONFIGURATION OF CLINICAL SERVICES

HALTON BOROUGH COUNCIL SCRUTINY PROCESSINITIAL FINDINGS

December 2003

1.0 INTRODUCTION

1.1 On 6th November 2003, Ian Dalton, Chief Executive Officer of the Hospital Trust presented his paper, “Clinical Services Review – A Road Map for our Hospitals’ Future”.

1.2 The Board of the Trust accepted this report, with a recommendation that the Trust work with key partners to develop action plans.

1.3 The proposals build on work undertaken by the Trust in 2002 and previously reported to Social Care and Health Policy and Performance Board. This work was summarised in a report “A Vision for Future Services”. However, this report previously approved by the Board of the Trust and consulted upon, is reported by the Trust, to have been superseded although no further comprehensive proposals have been published.

2.0 PROPOSALS FOR RECONFIGURATION – KEY ISSUES

2.1 Details of the proposals for change are set out in the Clinical Services Review Road Map. Essentially, they propose that all emergency surgical work be ceased at Halton General Hospital and transferred to Warrington General. This averages around 4.2 cases each day.

2.2 As a consequence of this shift, new capacity for elective (planned) surgery at Halton Hospital will be created. About 75 additional cases each week can be treated.

2.3 The proposed changes are reported to be based on best practice, clinical effectiveness and service efficiency. They should also positively affect recruitment and retention of key professional groups. In essence, by treating all emergency surgical requirements in one place, greater expertise can be assured and better patient outcomes delivered. In addition, by “protecting” elective services at Halton General Hospital, fewer operations will be cancelled and efficiency will be ensured. The surgical teams will be able to control care at all times, without the imposition of unplanned emergency work. They will be able to plan admissions and ensure adequate support is available.

2.4 Medical services, including the admission of emergency cases, will not be affected by the proposals.

2.5

3.0 PROCESS FOR SCRUTINY

3.1 The paper agreed by the Hospital Trust Board was shared with partner agencies on 6th November 2003.

3.2 On 6th November, the Scrutiny Panel met with Senior GP’s and PEC members of Halton PCT. The Chairman of the PCT Board also attended.

3.3 On 25th November, an informal meeting, open to all HBC members was attended by senior representatives of the Hospital Trust and Halton PCT. Appendix 3 provides details.

3.4 On 18th December, the Scrutiny Panel examined evidence from:-

Mr P Wake - Clinical Lead for Surgery, NCH Trust Dr T Rose - Medical Director Mr S Parry - CEO, Halton PCT Dr D Lyon - Clinical Governance Lead, Halton PCT

3.5 A range of informal discussions have taken place, with senior representatives of both the Hospital Trust and Halton PCT during the period since the proposals were published.

3.6 A range of issues have been raised with the Hospital Trust and PCT. Further scrutiny, including the PPB meeting, will address outstanding issues.

4.0 KEY FINDINGS OF THE SCRUTINY PANEL

4.1 The proposals in “Clinical Services Review – A Roadmap for our Hospitals’ Future”, represent contemporary thinking for hospital services. They appear to be based on best evidence, a determination to modernise services, provide additional capacity for the system and conform to the agenda for Patient Choice.

4.2 The proposals to focus emergency surgery at Warrington General Hospital, has clinical merit. By ensuring the surgical team is well resourced with consultant cover 24 hours a day, 7 days a week, better outcomes for individual patients can be assured. This view is fully supported by all the clinical evidence we took.

4.3 The proposals to develop elective (planned) surgery at Halton General Hospital have clinical merit. By protecting services, surgical teams will be able to ensure greater efficiency in the use of beds and up to 75 additional surgical episodes each week. The Trust will need to develop detailed plans for the change, which will need to be quantified and the clinical outcomes subject to detailed evaluation.

4.4 Whilst medicine at Halton Hospital is not directly affected by the proposals, the

need for surgical support/opinion for medicine is recognised. We are satisfied that, this position will not be compromised by the proposed changes. There will be sufficient sub consultant cover at the Runcorn Site with 24/7 access to a consultant opinion from the Warrington based team.

4.5 We are satisfied that support services, including pathology and radiology will be adequate. Though we recommend the trust explore the development of contemporary technological innovation, to support services.

4.6 The proposals, as currently developed, make only passing reference to whole system working. In particular, we identify the need to develop intermediate care, rehabilitation and support services. These developments are a key aspect of a modern service, where patient choice is adequately supported by Primary and Social Care Services. Whilst we had confirmation from the CEO of the PCT that investment should be forthcoming, we would expect to see this commitment confirmed in the Local Delivery Plan (LDP).

4.7 We believe the proposals constitute a substantial change to services. As a consequence, we would expect the Trust and PCT to have thoroughly consulted with public and patients. This is a requirement of the Health and Social Care Act 2001 – Section 11. This matter has been raised both by the CEO of the Borough Council and Chair of PPB. It will be essential that consultation is shown to be robust and meaningful. Future assurance on this matter is awaited.

4.8

4.9

Whilst not a specific part of the Clinical Services Review, the provision of 2 or more intensive care beds at Halton General is a key issue. Whilst the Trust has given an assurance that it is their intention to reopen the beds, they have failed to action this. All clinicians interviewed by the Scrutiny Panel support the re-opening of beds. This is critical, not simply for current service provision, but we believe the medium/long term future of Halton Hospital as an acute service.

Evidence presented to us, highlights the cost and complexity of this matter. Given the intention to sustain existing medical services, expand elective surgical services and host a Private Finance Initiative on the Runcorn Campus, they should, in our view, be re-opened without delay.

4.10 Whilst the Commission for Health Improvement may offer some guidance, the re-opening of the ICU beds may well prove to be an internal matter for the Hospital Trust. We will expect them to adhere to their stated aim, exercising the management control required, to re-start the service.

5.0 AREAS FOR DEVELOPMENT AND DETAILED EXAMINATION

5.1 Access to hospital services at a local level is essential to people in Halton. Many people in Halton rely on public transport. We do not believe this issue has been factored in to the proposals. Future examination, with detailed arrangements must

be developed.

5.2 In developing a comprehensive vision for future services, it is essential that the Hospital Trust and Halton PCT develop comprehensive services across the whole Health Community. The proposals for Clinical Services review, whilst substantial, are only one aspect of a total provision.

5.3 In developing services, the focus on patient choice, and a local health service will be important. For example, what opportunities will there be for improvements in outpatient services at Halton? Will Halton people be able to access a wider range of provision at their local hospital? These and other issues must form an overall strategic plan.

5.4 The proposals are based upon contemporary evidence and best practice. However, the trust must now develop a detailed action plan, providing timescales for implementation. This must be supported by clear processes to monitor and measure the actual impact of the changes. To include capacity gained and outcome for patients.

6.0 RECOMMENDATIONS

6.1 That whilst clinical evidence suggests that the proposals are well founded, they will only be successful, within a context of a more comprehensive, overall strategy, sensitive to the needs of the Halton community. Therefore, before proposals can be endorsed, we seek confirmation from the Boards of The North Cheshire Hospitals Trust and Halton’s PCT that the recommendations actions in paragraphs 6.2-6.9 of this report are accepted, taken forward and progress reported to a future PPB.

6.2 That North Cheshire (NCH) NHS Trust be recommended to explore and invest in improved technology to support it’s two centre operation.

6.3 That NCH Trust and Halton PCT develop detailed care pathways to ensure that the increased surgical capacity will be matched with appropriate, community based, post operative care and rehabilitation.

6.4 That Halton PCT confirm the commitment of it’s CEO to invest in rehabilitation/intermediate care/primary care services, and inter agency work with Social Services.

6.5 That arrangements for public/patient consultation on the proposed changes conform to the requirements of Section 11, Health and Social Care Act 2001.

6.6 That the two Intensive care beds at Halton Hospital are re-opened as soon as possible. With plans to expand this provision as required being adequately resourced.

6.7 That the arrangements for transport are fully examined and planned for, as part of

the detailed action plan.

6.8 That NCH Trust provide a full action plan, supported by a framework for the robust evaluation of the changes proposed.

6.9 That NCH Trust Board develop a clear long term vision for the Halton Hospital Campus as a essential part of Acute and Medicine Services. This to ensure appropriate health provision to the Halton community and to make best use of the capacity available. The existing proposals being only one part of overall service provision at both Primary and Secondary levels.

6.10 That the Hospital Trust provides some further clarification on their original report - Vision of Future Services. In particular, explaining why many of its recommendations have now been superceded.

7.0 CONCLUDING REMARKS

7.1 The Scrutiny Panel of:

Cllr T McInerneyCllr J StocktonCllr M MasseyCllr K Morley

Supported by:

John WebbAlex VilliersSteve Coveney

Are grateful for the help and co-operation of colleagues from both North Cheshire Hospital NHS Trust and Halton PCT.

DECEMBER 2003

Appendix 3

Please note that these are not verbatim minutes and if you wish to make further additions, please contact [email protected]

Clinical Services Review MeetingNorth Cheshire Hospital’s Trust

Tuesday, 25 th November 2003

Present: Mike Cuff HBC Diana Terris HBC Cllr L Temple HBC Cllr E Cargill HBC Cllr D Cargill HBC Cllr P Tyrrell HBC Steve Coveney HBC Cllr J Swain HBC Cllr K Loftus HBC Cllr J Devaney HBC Jim Wilson Halton PCT Daniel Seddon HPCT/HBC Cllr A H Taylor HBC Cllr M Massey HBC Cllr P Lloyd-Jones HBC Cllr T McDermott HBC Cllr F Fraser HBC Gill Cook HBC G Moran Halton PCT Dr D Lyon Halton PCT Mr M Frayne NCHT Cllr S Parker HBC Cllr R Gilligan HBC Kath Holbrook NCHT Dick Tregea HBC Cathy Edge HBC Cllr T McInerney HBC Cllr J Morley HBC Dr M Narayana Halton Cllr A Gerrard HBC Ian Dalton NCHT Mr Phil Wake NCHT Mr Paul Moody NCHT Cllr A Lowe HBC

Cllr E Jones HBC Mr Mark Tighe NCHT Mr Barry Taylor NCHT

Apologies: Mike Hall PM Cllr M Wharton HBCDerekTwigg PM Cllr Stockton HBCCllr A Cole HBC Cllr K Wainwright HBCStephen Parry PCT John Webb HBC

Item Discussion1.0

1.1

1.2

Introduction

Cllr T McInerney welcomed the representatives from North Cheshire Hospital’s Trust and Halton Primary Care Trust.

Cllr McInerney expressed his concern that Halton Hospital be best served

by North Cheshire Hospital’s Trust.2.0

2.1

2.2

2.3

2.4

2.5

The Review

Ian Dalton, Chief Executive of North Cheshire Hospital’s Trust, thanked Halton Borough Council for inviting him to this meeting.

Ian Dalton presented key points from the Clinic Services Review ‘A Road Map to our Hospital’ Future’.

After discussions with Hospital Staff, Ian Dalton was concerned that they did not have a clear clinical direction and with this in mind he re-visited the ‘Vision of Future Services’ document.

Ian Dalton confirmed that Halton Hospital will remain an acute hospital offering a current range of specialities and that Speciality Services will not be moving to Warrington. He also stated the Halton Hospital has an excellent capacity and we should look at the Services offered by both Hospitals and utilise them to their best. We need to ensure that:

1. Halton Hospital is secure as a major provider of services.2. The Trust is up front with the public in what they intend to do

He also stated that the Trust wants to bring more elective surgery to Halton. There is the capacity there and to offer people the choice to have their surgery at Halton, rather than Warrington, if they wish. The Trust want to centralise Emergency Surgical Services at the Warrington site.

3.0

3.1

3.2

3.3

The Local Clinical Perspective

Dr David Lyon, Clinical Governance lead, Halton Primary Care Trust gave a presentation ‘Emergency Care for Halton’.

In a Surgical Emergency

We may require:

Rapid access to Experienced Staff24 hour Operating TheatreBedsDiagnostic ServicesSub-speciality ExpertiseCross Speciality Support

In Halton

3.4

3.5

We have:

4 Emergency Admissions per day1 or 2 Emergency Operations per day (30%)3 Consultants on rotaTheatre is not open 24 hours a dayGaps in Specialist ProvisionGreater lengths of Hospital Stay

We are:

Closed to Admission 10% of the timeHigh Mortality Rate (as highlighted in DoH documentation, death rate shown after surgical admission with comparative units over a 3 year period)

Planned Surgery

We want:

Shorter Waits for Out-patientsVariety of Expertise and Skilled SpecialistsShorter Wait for OperationsAvoid CancellationsLocal After Care

Emergency Operations can contribute to cancelled operations and longer stays in hospital.

Proposed Changes

Acute cases be moved to Warrington24 hour dedicated Emergency TeamFull Support from other Clinical Teams and DiagnosticsShorter Hospital StaysHalton protected from Bed BlockingIncreased Number or Surgeons with a Wider Variety of Case MixAn Attractive Proposition for New StaffBetter Training Opportunities for Junior and other Staff(Halton Staff will rotate with Warrington)

Medical Admissions will not be affectedThere will be a greater need for High Dependency Unit (HDU)Major Expansion of planned Admissions would be possibleITU would be more necessary for Medical AdmissionsRare for Surgical Admissions to require ITU bed

3.6

3.7

Dr Lyon stated that questions had been raised about the safety of the ITU at Halton and that they are still awaiting the results of the Commission for Health Improvement (CHI) assessment. We will not know what is going to happen to the ITU until the CHI assessment results are available.

How will we know it works

Continue to Examine Mortality RatesReduced Lengths of Stay in HospitalNumber of Out-patients seen on Halton siteAssessing the Number and Types of OperationsReviewing Waiting Times for Out-patientsReviewing Waiting Times for OperationsReviewing Number of Cancellations

In Summary

Dr Lyon stated that the Acute Surgical Services for Halton Residents will Improve. Planned Surgery at Halton will be expanded.Hospital will be a vibrant and attractive place to work and learn in.There will be no change for Medical Emergencies.

4.0

4.1

4.2

4.3

The Impact on Primary Care Services in Halton

Daniel Seddon, Director of Public Health and Health Strategy, presented the Primary Care Trust Board’s point of view, on behalf of Stephen Parry, of the Clinical Services Review.

Daniel Seddon agreed that there are positive benefits around focussing the Surgical Emergency Services at Warrington, however, planned Surgical Beds may still be taken by Emergencies and this is something that will need to be worked at. Daniel Seddon stated that the PCT aim to promote and improve health and there are three issues that we need to focus on:

a. Transportb. Organisational Integrityc. Health Benefits and Promises

Transport

Patients, staff and visitors will need to travel from Halton to Warrington/Warrington to Halton sites for treatment on occasions and this is an opportunity to look at Patient Transport Services as a whole. We do not want to make the situation worse for patients. The NHS is a big contributor to the traffic ‘chaos’ and we have a responsibility to the

4.4

4.5

Corporate citizens not to make this worse.

Organisational Integrity

In the past there have been experiences of mixed messages being communicated from within the organisation. Promises from the Board will only be made when they are sure they can be delivered.

Health Benefits and Promises

PCT view from PEC is that these promises can be delivered. It is very important that the delivery is actively managed and that expectations and promises are confirmed by robust methods of evaluation.

5.0

5.1

5.2

5.3

5.4

5.5

5.6

Questions to Presenters and Hospital Team

Q. Cllr T McInerney stated that he understood that Halton was to be a largely ‘cold’ site and that ITU beds would be required for Medical Patients. He outlined concerns that had been raised in a letter by Surgeon, Mr Jim Johnson, regarding the viability of services if the ICU beds are not reinstated??

R. Mr Phil Wake, Surgeon Representative, replied that the Trust have no problem about the ITU beds being re-opened and outlined the use of ITU beds for Critical Care;

‘ITU is used for critical care for the critically ill patient. Most patients are nursed on a normal General Ward. If they are less well and require more monitoring and more technical expertise they could be transferred to the Critical Care Unit namely a High Dependency Unit (HDU) or Intensive Care Unit (ITU/ICU) bed. The majority of patients requiring Critical Care are managed by the HDU spectrum of Critical Care. The number of patients that require ICU are a relatively small percentage and most of these come through as Emergency Patients. We would like to see this service expanded.’

R. Dr Lyon responded stating that the PCT Commissioners would like to see the ITU open as soon as CHI make its decision and hopefully this will be within a reasonable period.

Q. Cllr L Temple outlined his concern that service users would have to travel to Warrington to receive Emergency Services.

R. Daniel Seddon replied that the PCT/Trust hope to develop a reasonable plan for both sites and that with the two sites together there would be greater resources.

5.7

5.8

5.9

5.10

5.11

5.12

5.13

5.14

R. Ian Dalton stated that there were a number of patients already travelling to Warrington for surgery and hopefully this would reduce the number of journeys from Warrington to Halton. More patients would be treated locally, less patients would have to travel. There are already 30 Halton surgical patients currently treated at Warrington per week and that the Trust would be happy to discuss ways of improving transport with the PCT.

Q. Cllr M Massey asked how Halton Hospital would be able to manage the medical emergencies if it does not provide 24 hour services?

R. Ian Dalton replied that they were under extreme pressure at the moment and did not think it was fair to assess them on the last few weeks. There has been a particular spike of emergency cases nationally and other trusts were also feeling the pressure at the moment. There is a Government grant of £180,00 for looking at how best to manage patient resources. A big pressure on surgery comes from medical emergency. Ian Dalton believes these changes would be better for patients on both sites and did not think they were in any way at conflict.

Q. Cllr D Cargill was concerned that the Trust had not considered the social make-up and fabric of Halton. The Council was trying to improve the status of Halton and he felt that services were being taken away from Halton eg. Children’s Services. He was also concerned about the parking at Warrington Hospital asked what endeavours were being made regarding a suitable transport system for people travelling between the two hospitals?

R. Ian Dalton explained that Paediatric Surgical Services were removed because of the safety issues. Children can only undergo surgery when a Paediatric Anaesthetist is in attendance and other suitably qualified staff. Halton does not have that back up available.

R. Kath Holbrook, NCHT – stated that the Trust are looking at which other services we might be able to develop on the Halton site.

Q. Cllr Tom McInerney stated that a decision should be made as to whether these Services are going to be put on the Halton site.

R. Ian Dalton replied that the Trust were not going to make promises that they did not know they could deliver. He stated that the reality of the Health Services is that expectations rise and the Services will change. He stated that he could not promise that this process would reduce the need for transport between the two sites and obviously this would be open to discussion. However, if people want the Trust to give more this would be at a cost which he thought would be hard to justify given the overall financial position of the Trust. He would like to make sure that the maximum is spent on patient care and that we have to be very clear about

5.16

5.17

5.18

5.19

5.20

5.21

5.22

5.23

5.24

our priorities but is open to debate about this.

R. Dr Narayana, GP Representative – stated that local doctors are in support of this. He believes that if we delay further Halton is in danger of becoming a very minor hospital. These changes will benefit the people of Halton and we should support the proposals to improve the services. Within the modern NHS there is a need for particular arrangements for Specialist Services. Surgeons carrying out 200 specialist cases a year get better results. Historically Halton has had ‘General’ type surgeons who perform many different operations and we have to accept that this is not acceptable any more and we will have to increase the number of Specialist Surgeons available for Halton. The needs of the Halton population are very great and we need this modern Surgical Team.

R. Mr Phil Wake, Surgeon Representative, - agreed that this is a very exciting development. There is a whole range of things we can do. We are talking about expanding the services and what we would hope to see is a more controlled, planned service extending right across the board performed by a much bigger Team. If there are more surgeons on site then there is more choice and access for patients.

R. Daniel Seddon – stated regarding transport that we have to challenge the process. The PCT has a responsibility to prevent illness and improve health. We need to think about the effects of service change and look at this as a community. The position we have is resolvable.

R. Cllr T McInerney agreed that transport is important but that is was not going to be resolved tonight!

Q. Cllr S Parker raised his concern that there seems to be lack of communication within the Trust and the PCT?

R. Ian Dalton replied that he has started an ‘open forum’ within Halton where members of staff can come along and quiz him on any issues and that he would be holding regular meetings with Chief Executives, Board Members and GP’s.

Q. Cllr Mrs E Cargill was concerned that other services would also be moved from Halton to Warrington Hospital.

R. Ian Dalton reiterated that he did not think it was in the best interests of children to have their surgery at Halton Hospital.

Q. Cllr T McDermott asked for an explanation of the mortality figures and stated that offering training and a more interesting environment for surgeons was not addressing the wants/needs of the patients. He also stated

5.25

5.26

5.27

5.28

5.29

5.30

5.31

5.32

5.33

5.34

that Warrington patients were being given the choice to travel to Halton for their treatment if they wished, but Halton patients were not being given that choice and that Halton Borough Council, not having any representation on the NCHT Board, could not influence this.

R. Ian Dalton replied that there is a National shortage of doctors and Halton has a number of places that need to be filled and that it was essential to offer a vibrant position with a wide range of training and services.

R. Mr Phil Wake, Surgeon Representative, stated that it was important to note that they could not guarantee that these changes would reduce the death rate in Halton. There could be a number of factors contributing to these figures but some of the issues being addressed ie. specialist surgical expertise, long stays in hospital could help to improve these figures.

Q. Cllr T McInerney asked if a patient could be put in mortal danger by being driven to Warrington in an emergency situation when Halton Hospital is much nearer.

R. Surgeon – replied that this situation is already happening as Halton is not providing 24 hour theatre cover.

Q. Cllr P Lloyd-Jones asked for a further break down of the mortality rates with a comparison to Warrington’s mortality rates and asked if there were any proposals to increase the quality of care in Halton.

R. Mr Phil Wake, Surgeon Representative, replied that the Warrington mortality figures were much better and that the information could be found on the Department of Health’s website and that the changes that were being suggested would help to improve care.

R. Ian Dalton replied that his clinical view was that patients would have a better outcome if Emergency Services were centralised at Warrington.

R. Dr Narayana, GP Representative, agreed and stated that the poor outcomes for emergencies could be due to there being on dedicated on call surgeon. At Warrington there are dedicated surgeons.

R. Daniel Seddon added that the mortality rate information was actually quite dated and that we need to look at this and see if there have been any changes.

Q. Cllr P Tyrrell stated that the Council had been promised a decision regarding the ITU in August of this year and were still waiting for that response.

5.35

5.36

5.37

5.38

5.39

5.40

5.41

R. Ian Dalton replied that he was not aware of this promise and that he believed that CHI usually respond within 3 months but he was hoping for further discussion with CHI next week.

Q. Cllr A Gerrard asked if there were any plans for working with Primary Care.

R. Ian Dalton stated that they had key representation available for dialogue with PCT’s and GP’s on this issue and a meeting is to be held on 12th December to discuss Care Pathways bringing providers together to look at each others practices.

Q. Cllr J Morley thanked the Medical Team for sparing the time to attend the meeting and asked when the Trust were going to be consulting the public regarding these proposed changes in service.

R. Ian Dalton stated that they were consulting the public by having this discussion with the Councillors this evening and were happy to attend any committees for discussions.

Q. Cllr T McInerney asked if there was a suggested time scale for the transfer of services.

R. Ian Dalton replied that there was no time scale but in the interest of the patients he felt this should be done as soon as possible.

6.0

6.1

6.2

Summary

Cllr T McInerney summarised that the Trust, the Surgical Team, PCT and GP’s were in agreement that they felt this transfer of services should go ahead.

Cllr McInerney thanked the presenters for giving the Councillors the opportunity to ask questions and hoped that there would be further opportunities for discussion in the future.