The Board considered a report of
the Strategic Director, Communities which provided information and highlighted
concerns relating to the review of the Non Arterial Centre Designation on Warrington Hospital and the people it serves.
The report advised that at a
Special Meeting of the Health Policy and Performance Board, held on 28th
June 2011, Members had considered a report on the Cheshire
and Merseyside Vascular Review of the impact of non-arterial centre designation
on Warrington Hospital and the people it serves.
It was reported that Dr. Tom
Dent, Project Director, Cheshire and Merseyside
Vascular Review, Mr Simon Banks, Operational Director, NHS Halton and St Helens
and a representative of the Cheshire
and Merseyside Review Board, and Jackie Robinson, NHS Knowsley
had attended the meeting. The Board had
been advised that the Cheshire and Merseyside
Vascular Review project board had recommended that Warrington and Halton Hospitals NHS
Foundation Trust should not be designated as an arterial centre. The minutes of
the meeting were recorded as follows:-
“The Board also noted that Warrington was in the
process of recruiting two more vascular surgeons and queried whether they could
re-submit an application to the Vascular Review Board. In response it was noted
that Warrington could re-submit an application
to be an arterial centre, however they would have to prove that they met the
criteria as effectively as did Chester and Liverpool.”
The Board was further advised
that following the Health PPB meeting there had been an email exchange between
Mr Simon Wright from Warrington and Halton Hospital Foundation Trust and Dr Tom
Dent (Project Lead) and the Chair of the Health PPB.
It was reported that Mr Tom Dent
had stated that “With respect to the resubmission, I have no recollection of
saying that this would be possible. I wonder if my remarks were misunderstood.”
Subsequent to the email exchange,
it was reported that the Chair of the Health PPB would like to challenge the
process followed within the review as the Liverpool and Chester
hospitals were given time to refine (not resubmit) their application and Warrington and Halton Hospital Foundation Trust and St
Helens and Knowsley
Hospital had not. In addition, consideration of this was also
being undertaken jointly with Warrington’s
Overview and Scrutiny Board.
Mr
Paul Brickwood, Director of Finance & Commissioning Knowsley
Health & Wellbeing, attended the meeting to clarify the current situation
in respect of the review. Mr Brickwood reported
that there would be a better outcome for patients if the high end arterial work
was centralised. He also reported that the
proposal ensured there was sufficient arterial activity across the area and there
was not a sufficient number of cases to ensure the best possible outcome if there
were more than two centres. In addition,
he added that Warrington
had not been recommended as an arterial centre as there would need to be a significant
increase in activity in order to meet the clinical standards. The recommendation, he reported had been made
after consultation with clinicians. A decision
/ assumption had also been made that the impact on not having the arterial centre
at Warrington
would be low as a large number of people had indicated in the public consultation
process that access was less important than health and safety. He indicated that patients were already travelling
to other areas such as Liverpool to access specific
services.
The following comments were raised by Members of the Board during the discussion:-
· Concern was raised at the inappropriate
timing of the review / decision. It was
highlighted that at the time of submitting the bid Warrington were still in the
process of developing improved services i.e the
stroke Unit which would deliver improvements for Halton residents;
·
Warrington and Halton Hospital Trust were now in a
position to meet the criteria and would like to be given the same opportunity as
Liverpool and Chester
to refine their response and resubmit their bid, which would evidence how they
meet the criteria. In addition, the new
developments in Warrington would result in GPs
referring more patients to the hospital instead of Liverpool and this would
increase the volume of activity as previously the services were not available
in Warrington.
·
The review had been undertaken in
isolation and the impact on other secondary care services had not been
considered at the time of the review.
There was also a possibility that if the high end arterial surgery was
taken out of Warrington
this would impact on the hospital being designated as a trauma unit;
·
Manchester
were establishing three centres and had a similar
population. They and other areas had
used a different criteria (75 not 100).
The same criteria should have been used.
Mr Brickwood replied that Manchester
was a much bigger area. The Board disagreed
with this comment;
·
Clarity was sought on why the decision was
for two centres as opposed to three? It
was reported that it would be better to have three centres, one of which would
be placed in Warrington. In response, Mr Brickwood reported that he felt
there was not a sufficient footprint to justify three arterial centres. The Board disagreed with the response;
·
It was reported that there would be a
sufficient volume of activity / footprint if the centre was in Warrington
rather than Chester. Warrington was
also more central than Chester
in respect of the rail and public transport infrastructure;
·
Members of the Board highlighted that an impact
assessment should have been undertaken before any recommendation or decision
was made. The Board felt that the recommendation
had failed to take account of the significant social and economic deprivation
in Halton and the ageing population. The
ageing population in Halton had also doubled. It was reported that arterial
surgery predominantly occurred in people aged 75+, very often vulnerable
people, who relied on friends and family to visit them in hospital. Chester
was inaccessible via public transport from Halton and these patients would not
be able to have any visitors during their stay.
Receiving visitors was a vital part of a patients
recovery. In addition, there had already
been a significant problem ensuring patients could get to Warrington Hospital
from Halton. As a result of the
difficulties, a bus service had been established. It was emphasised that it was crucial that an
impact assessment was undertaken before any decision was made.
In response, Mr Brickwood reported that the recommendation
had been as a result of a clinical consensus. However, it was only a
recommendation and the Board would make a decision at the end of September
2011. A decision had been taken on what
the impact would be after a public consultation exercise. The timescale of the
impact assessment had not been determined;
·
Chester
is an affluent city and did not have the scale of social and economic
deprivation as Halton. It was on the
periphery of the whole area, whereas Warrington
was central to all road and rail infrastructures and public transport. It was much more accessible for all than Chester;
·
It was suggested that If
there was a third site in Warrington, there
would be no need to send people to Liverpool
for any type of vascular surgery. In
light of the points raised, and having stated that the review had not been done
to make a financial saving, clarity was sought on the option of three centres
could not be progressed? In response,
Mr Brickwood reported that he felt there was not sufficient activity to justify
three arterial centres;
·
There would need to be some expansion work
undertaken in Chester to take on the additional arterial work, whereas
Warrington, did not need any alterations, everything was now in place i.e surgeons, staff, radiologists and theatres in a central
accessible location;
·
Patients choice had not been fully taken
into account - the patient /public
consultation responses had been misrepresented;
·
Chester
relied on Deeside to meet the criteria in respect of the volume of
activity. Deeside was in Wales. Warrington had
a sufficient volume of activity to meet the clinical standards within the area
to justify a centre without importing patients from outside of England;
·
There would be a negative impact on staff
who did not work in the arterial centre – they would be de-skilled and would
not receive the training/experience they required;
·
NWAS Category A
performance would suffer in the mid Mersey area as more ambulances would be in Liverpool transferring Halton patients and not responding
to emergency calls. This would put
Halton residents at risk;
·
As Chester
would be inaccessible to Halton residents, the majority would choose to have
surgery in Liverpool, which would result in
them being unable to cope with the volume of activity. The population across the area of Whiston, St Helens, Warrington,
and Halton is half a million. This would subsequently increase the waiting
lists and put Halton residents at risk. Warrington
were already in a position to accommodate this volume of activity;
In response, Mr Brickwood reported that assuming
the consultants networked, Liverpool were confident
that they could cope with the referrals and they would also investigate alternative
ways of using the Broad Green Site; and
·
It was agreed that a copy of the criteria
used and how the recommendation had been made be circulated to Members of the
Board.
In conclusion, the Members of the
Board agreed with the proposal for centralisation, but disagreed with the recommendation
of two sites and that one of the sites should be located in Chester. Warrington, they agreed would be a better
option because of the points raised above.
RESOLVED: That
(1)
the
report and comments made be noted;
(2)
the
comments be forwarded to Mr Paul Brickwood for presentation to the Chief
Executive for consideration at their meeting on 25 August 2011; and
(3)
Mr P
Brickwood be thanked for his attendance at the
meeting.
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