"Closer to Home"

I have taken part in a number of discussions at the "Save our Services" group in the past few weeks, including some with representatives of the trust and some with doctors.

There are a number of messages which are becoming very clear, but the most important single problem with the present consultation document is the statement that major trauma treatment will be concentrated at Carlisle.

This statement, if taken literally, represents a serious downgrading of the ability of the West Cumberland Hospital or its successor to cope with some of the most seriously ill or injured patients, and could be very bad news for those patients and for the hospital.

I believe it would be unacceptable to the community to approve the consultation document with this statement and I am hearing that it would also be unacceptable to at least some doctors.

I hope that everyone will send a clear message to the trusts that this policy should not be approved. The public meeting on 14th January at 7pm at Whitehaven Civic Hall is one place to do that but I hope that every resident reading this who agrees with me will also write in and send the same message to the trust in your own words.

Patients admitted to meet targets at cost of £2 billion

According to today's Times, targets intended to cut waiting times for A&E have had the effect of causing two million extra hospital admissions over the past five years at a potential cost to the NHS of up to £2 billion.

The extra cost comes because patients who are in danger of having to wait more than the target time of four hours have been admitted to hospital "just in case".

The figure of two million extra admissions in England comes from research by the CHKS group, an independent provider of healthcare information. However, there has been no corresponding increase in admissions in Scotland or Wales, where the four-hour target does not apply.

Whenever you set a target or an incentive, it is important to think through what behaviour it is likely to encourage, and whether this is the behaviour that you want. It would appear that this had not been done in the case of the four-hour target.

Public meeting dates confirmed

I have now had it confirmed to me in writing that the following meetings will be discussing the impact of the "Closer to Home" hospital consultation

Thursday 18th January, Copeland Centre - special meeting of Copeland Council's relevant Overview and Scrutiny Committee to discuss and question witnesses about the "Closer to Home" NHS proposals. The meeting will run from 10 am to early afternoon.

Tuesday 22nd January, Copeland Centre, 4pm. January meeting of Copeland Council. The agenda for this meeting of the full council will include consideration of recommendations from the Overview and Scrutiny committee about the hospital proposals.

It has also been confirmed that the PCT's public meetings in Copeland on the subject will be held on Monday 14th January from 7pm to 9pm in the Solway room, Whiteaven Civic Hall, and on Monday 21st January from 2pm to 4pm in the Network Centre, Millom School.

"Closer to Home" public meetings

It was suggested at one stage that the public consultation meetings in Whitehaven and Millom on the "Closer to Home" proposals might be postponed. This does not appear to have happened.

The Whitehaven meeting is still scheduled to take place at 7pm on Monday 14th January in Whitehaven Civic Hall, Lowther Street.

The Millom meeting is still scheduled to take place at 2pm in the Millom Network Centre (at Millom School) in Salthouse Street.

These are two of the five public meetings being organised: there are three others in different parts of Cumbria.

You can keep a check on the progress of the consultation by looking at the "Closer to Home" website at

http://www.closertohome.org.uk/

Who runs the NHS in Cumbria?

I was asked a question this week - which trust is responsible for the NHS in Cumbria?

It's a good question because there is no one answer.

The "Purchasing" authority for health services in Cumbria is the Cumbria PCT which commissions health care in the county. This body decides which hospitals and trusts to "buy" health care services from and can therefore effectively close hospitals or open new facilities.

However, the actual running of services is done by a range of different trusts and bodies. Acute hospitals serving the West, North, and East of Cumbria are managed by the North Cumbria Acute Services trust which runs the West Cumberland Hospital in Whitehaven and the Cumberland Infirmary in Carlisle.

Morecombe Bay NHS trust runs the acute hospitals in South Cumbria such as Furness General Hospital (FGH) in the Barrow area, though this trust also covers some of Lancashire.

Our Ambulance service has, sadly in the view of many people, been regionalised and is now run by a North West ambulance trust.

Overarching policy for the region is set by the Strategic Health Authority serving the North West.

Many of these trusts are in the process of applying for "Foundation Trust" status which would give them more autonomy and control over issues such as the right to raise their own funds but would also make them more subject to local democratic influence.

There is a strong argument that there are currently too many tiers of administration in the NHS and that the structure should be simplified. The Conservatives fought the last election on a platform of abolishing the Strategic Health Authority level, devolving responsibilities to the next tier down, and diverting any savings which resulted to patient care.

Though the present government attacked this at the time, they have since halved the number of Strategic Health Authorities.

Foundation Trust Status discussion

The issue of "Foundation Trust" status for the North Cumbria Acute Hospitals was discussed at Copeland Council this afternoon.

Not for the first time, there was some confusion evident about which of the multiple NHS consultations which are in progress was affected.

By my count there are no fewer than five NHS public consultations affecting all or part of Copeland which are either underway now or due to start early next year.

1) The "CLOSER TO HOME" consultation about the future of the West Cumberland Hospital in Whitehaven, the Cumberland Infirmary in Carlise, and all the community hospitals in North Cumbria including those at Keswick and Millom. This consultation has been extended to 1st February and is the subject of heated debate.

2) An equivalent consultation about hospitals in South Cumbria and Lancashire which is due to start early next year and which may have significant implications for Furness General Hospital in Barrow.

3) A Mental Health care consultation for Cumbria as a whole, also due to start early next year.

4) Foundation Trust status for the North Cumbria Acute Hospitals Trust - this is about new governance arrangements for the part of the NHS which runs the West Cumberland and Carlisle hospitals.

The idea is that as a Foundation Trust the acute hospitals organisation would have more independence within the NHS and strengthen public participation. Local residents would be able to become members of the Trust, and would then have a vote in electing the "Governors" of the trust, who in turn would elect key members of the trust board.

5) There is a similar consultation about Foundation Trust status for the Morecombe Bay hospitals trust, and a number of parishes in the South of Copeland are among the consultees for this.

I gave a very guarded welcome to the Foundation Trust status proposals as they appear to address the democratic deficit which has been building up in the NHS in the past ten years, beginning with the abolition of Community Health Councils and continuing with the abolition of their replacements, the Patient and Public Involvement Forums.

If these Foundation Trusts do get set up, it will be important that as many residents as possible take up membership (which is free.) But in the meantime we need to be extremely vigilant about how the arrangements for Foundation Trust status are progressing and what the consequences are for funding and services.

"Closer to Home" public meetings may be postponed

I was told on Friday that the public meetings for the "Closer to Home" consultation in Whitehaven and Millom had just been scheduled for 14th January and 21st January respectively.

However, I have now been further advised that, that evening, during discussions between the NHS trusts, local consultants, and civic leaders, the suggestion was made that it would be a good idea to put these dates back a little.

The purpose of the delay is so that the PCT and the acute hospitals trust can hold further meetings with the Consultants at the West Cumberland to try to address their concerns and provide agreed answers to some of the questions the public are asking.

Watch this space for further news on the revised dates.

Dates for Public Meetings

The public meeting in Whitehaven to discuss the "Closer to Home" health proposals will be held on 14th January.

The Millom public meeting will be held on 21st January

Further details to follow.

POSTSCRIPT

I have now heard that these dates may be put back a week or so. Please see next post for more detail

"Closer to Home" discussed at Keswick Forum

I attended an interesting discussion this evening at the Keswick neighbourhood forum about the "Closer to Home" proposals.

It was a very calm and civilised discussion. Two important things came out of it

1) Members of the public are very concerned about the number of beds which our hospitals will have. The impression most residents have from the document is that it will mean fewer beds at Keswick hospital. The Trust were not able to give a clear answer on whether this is correct.

2) One important aspect of "Closer to Home" is supposed to be that GPs will take a leading role. Local residents would be very interested to know what GPs think about the proposals.

Foundation Trust proposals to be postponed ?

I have heard from two completely independent sources that the North Cumbria Acute Hospitals NHS trust will be dropping back the bid for Foundation Status from March to July.

Both sources also separately advised me that the Trust isn't planning to make any public announcement about this.

For all I know there may be very good reasons to delay the proposal, but I doubt if it is a good idea not to explain to people what they are.

Closer to Home roadshows and Neighbourhood Forums

Presentations about the "Closer to Home" proposals for local hospitals, and an opportunity to answer questions, will be provided at roadshows in Keswick and Whitehaven next week.

On Monday the NHS proposals will be the main item for debate at the Keswick forum at the friends meeting house, and on Thursday they will form part of the agenda at the Hensingham and Hillcrest forum at Hensingham sports centre.

Both meetings start at 7pm