Monday, December 19, 2016

Submission on the Success Regime for Cumbria

This is the submission I sent in on behalf of the Executive of Copeland Conservative Association to the consultation document
"The Future of Healthcare in West North and East Cumbria."

Copeland Conservatives submission on the Success Regime Consultation

A: Maternity – We support Option One

We have a number of concerns about the current "Success Regime" consultation and particularly our fears about the safety of the current "preferred option", Option 2, for maternity. We believe that Option 2 will increase risk to those mothers who need rapid intervention such as "Crash Caesarean sections" and their babies.

We believe that the idea that a consultant-led maternity unit is unsustainable is open to challenge and note that Option 2 for a midwife-led unit at West Cumberland Hospital has been publicly opposed by all the current consultant obstetricians based at the West Cumberland Hospital and respected former consultants such as Mr John Eldred who worked at the hospital for over twenty years. The plans are also opposed by many local midwives who have publicly warned that these plans put the lives of mothers and babies at risk.
Option 2 does not take enough account of the distance between the West Cumberland Hospital and the Cumberland Infirmary in Carlisle. Because of the nature of the roads between them the 40 mile journey between these two hospitals can regularly take anything up to an hour and fifteen minutes sometimes longer on occasions. During the recent visit of Phillip Dunne to the hospital this is the amount of time in which was set aside for the journey in his itinerary. Residents of South Copeland some of whom already face journeys of up to an hour to get to West Cumberland Hospital could be potentially be facing a time requirement of over two hours to get to the Cumberland Infirmary, counting first the time for the ambulance to get to them – which in some remote areas can be over half an hour - and then the journey to the hospital. Whatever statistics are quoted by both sides, there is no reasonable doubt that for those women who require urgent intervention, such as "Crash Caesareans" this huge increase in journey time will put them, and their babies, at increased risk. Hence we do not agree that the success regime preferred option would achieve, in the Prime Minister’s words, "a safe maternity service for mother and baby."’

Many local healthcare professionals at every level do not agree either and hence there is no medical consensus for option 2.

We believe that the arguments put forward for Option 2 on maternity understate the difficulties local geography poses to the ambulance service in getting to people. We already have emergency medical cases sometimes brought to hospital in police cars when the ambulances are overstretched: the success regime maternity proposals could significantly exacerbate this problem.

The idea of a dedicated maternity ambulance may sound good, but actually we do not believe that the solution to the enormous challenges facing the ambulance service in this area, either with the existing pattern of hospital services or under any of the other options considered in the documents, will be helped by balkanising the ambulance service into sections dedicated to particular types of care. The greater the flexibility of the ambulance service, the greater its ability to deal with the range of patient needs which may come through.

When a national team of independent assessors looked at maternity services in Cumbria two years ago, their report stated that before their visit they had expected to recommend a single maternity unit for the entire county but when they actually saw the hospitals and the roads between them they changed their minds. Their preferred option included keeping consultant-led maternity at West Cumberland as well as Carlisle.

There has been a long-standing issues of recruitment which the Trust and West Cumberland Hospital faces and which the consultation rightly seeks to address. This is common to many hospitals in the North West, but it has not helped recruitment at the West Cumberland Hospital that there has been the constant discussion of downgrading services at the hospital over the last ten years which has directly lead to consultants leaving. We are convinced that a more positive approach in which the Trust demonstrated their commitment to keeping services, while extending and better publicising the excellent work being done jointly with the University of Central Lancashire to raise the status of West Cumberland Hospital, could help.

This applies both to maternity services and Paediatrics. We believe it is essential to launch a new recruiting drive for both disciplines in particular, and for all others where there are shortages of key staff, which makes more of the enormous attractions of West Cumbria as a place to live, which looks at options to provide accommodation, which uses the work being done with UCL to build up the status of WCH. We also believe it would be very helpful if the trust could do more to talk to existing medical and other staff and establish more of a genuine dialogue about the barriers to improving morale and retention of staff as well as recruitment.

Finally we want to point out that there are already significant pressures at the Cumberland Infirmary at Carlisle: it was very recently reported that they had to divert pregnant women and children to the West Cumberland Hospital over the weekend as they did not have the capacity to cope with the demand. The success regime proposals could overload them further.

B. Children’s Services – We need paediatric care at WCH and Option One may not be enough. Options 2 & 3 certainly are not.

In order to maintain the consultant-lead maternity services which we believe are essential, we need to make sure there is a good paediatric support. Less than ten years ago the children’s services department at West Cumberland Hospital was winning national recognition.

We would not be consistent in expressing our strong support for consultant-lead maternity at West Cumberland so that expectant mothers who need rapid intervention can receive it if we did not also support making sure that adequate paediatric support is available at all times to ensure this policy is safe.

For that reason we regard option 2 and 3 as totally unacceptable, but even under Option 1 we are very concerned about the proposals for no night-time admissions.

In response to the comments in the consultation document ab out the need for a dedicated transfer service, we repeat our concerns that overspecialisation of the ambulance services into dedicated sub-groups could impair patient safety by making the service less flexible and efficient, although where specialist equipment is needed in ambulances serving particular functions – e.g. specialist equipment to transport very young patients who are seriously unwell, for instance – there will be exceptions to that principle.

We recognise the challenges of delivering this with present staffing levels and believe that everything we wrote in the previous section of this response about maternity recruitment and retention also applies to paediatrics. Indeed, as some of the midwives have suggested during the consultation, the measures which have been successfully used to boost maternity recruitment and retention should also be applied to children’s services.

C. Community Hospitals – We support Option 1

Our community hospitals are of vital importance. We welcome the proposal to plan for 104 beds and avoid any community hospital closures. We believe the proposal for six sites is the best of the four options.

D. Emergency and Acute Care – We support Option 1

We believe it is essential to maintain 24/7 emergency and acute care at West Cumberland Hospital and any other outcome would be a disaster for the area. We welcome the flexible thinking represented by the proposal for a new workforce model. Most of the comments we made in the first part of this submission about recruitment and retention also apply to emergency and acute care.

E. Hyper-Acute stroke services – We support option 2

We want to see as many services as possible provided at West Cumberland Hospital, However, on balance, the benefits of a new Hyper-Acute stroke unit at Carlisle make this option one we are prepared to consider. We would want the impact on stroke patients of travel from West Cumbria kept under review as this would remain a subject of great concern.

F. Emergency surgery, Trauma and Orthopaedic services

We welcome the proposal to bring some of these services back to West Cumberland Hospital. We would like this to go further as and when it is safe and practical.

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