How the assessors changed their minds ...

The independent assessors who looked at Maternity services in Cumbria and North Lancashire reported that they had originally intended to recommend one huge maternity unit for the whole vast area.

Fortunately when they saw what the roads and transport links are actually like they changed their minds. It was reported that:

"While prior to their visit the assessors felt this was likely to be a preferred option, because of the benefits that such a larger unit with 5,000 deliverie...s would have for women and their babies, given the geography involved they did not think that this option could realistically be developed further."

Instead their preferred solution was Option One:

Option 1 - Four consultant-led maternity units at Carlisle, Whitehaven, Barrow and Lancaster. The immediate development of midwifery-led units at Carlisle and Lancaster, on the same site, or next to them.

But we cannot take for granted that this solution will be adopted, it is one of three options under consideration and there are conditions being laid down.

That's why we must campaign to keep consultant-led maternity at all four sites and ‪#‎SupportOption1‬

To keep maternity at the West Cumberland please tweet #SupportOption1

If you think it is essential to keep consultant-led maternity services at West Cumberland Hospital, and for the NHS trusts to undertake the necessary measures recommended by the assessors to make sure this option works, please show your support by tweeting ‪#‎SupportOption1

SUPPORT OPTION ONE

The ancient Roman statesman Cato the Elder felt so strongly that Carthage must be destroyed that he ended every speech he made in the Roman senate, regardless of the subject, with words to that effect, sometimes quoted as "Ceterum censeo Carthaginem esse delendam" (Moreover, I consider that Carthage should be destroyed.) but most often as "Cathago Delenda Est."

I feel equally strongly that we must make sure the NHS Trusts adopt the preferred option for maternity services in Cumbria and keep consultant-led maternity services at West Cumberland Hospital.

If we want to keep West Cumbria viable it is vital that all residents make the NHS trusts aware they have to run with this option, which is called option one.

That's why from now on until that option is agreed and confirmed, with all the necessary support to make it work, when I write and article on my blog or on Facebook, when I write a campaign leaflet, I will finish with these words: SUPPORT OPTION ONE!

SUPPORT OPTION ONE !

An independent review has outlined six options for the future of maternity services in Cumbria and North Lancashire.

The preferred option would mean consultant-led maternity services would remain at the Cumberland Infirmary in Carlisle, and the West Cumberland Hospital in Whitehaven.

I strongly support option one, and I believe the community will  do so too:

WE MUST CAMPAIGN TO MAKE SURE IT HAPPENS

The following options were recommended by assessors:

• Option 1 - Four consultant-led maternity units at Carlisle, Whitehaven, Barrow and Lancaster. The immediate development of midwifery-led units at Carlisle and Lancaster, on the same site, or next to them. To evaluate whether midwifery-led units could be developed at Barrow and Whitehaven. This is the preferred option.
• Option 2a – Two consultant-led units at Carlisle and Lancaster and developing two on the same site or next to midwifery-led units at Carlisle and Lancaster. This is the assessors’ second favoured option should it not be possible to achieve Option 1. It would mean the closure of consultant-led units at Whitehaven and Barrow. The report says this option would be more likely to provide better medical cover for women and babies, but could lead to increased travel time and costs for people in West Cumbria.
• Option 2b - Two consultant-led units at Carlisle and Lancaster, developing two on the same site or next to midwifery-led units at Carlisle and Lancaster, while converting the consultant-led units at Whitehaven and Barrow to become ‘free-standing’ midwifery-led units. This would require significant investment in midwifery training in West Cumbria.

The final three options have not been recommended by assessors:

• Option 3 - Three consultant-led units at Carlisle, Lancaster and Whitehaven and developing on the same site or next to midwifery-led units at Carlisle and Lancaster.
• Option 4 - Three consultant-led units at Carlisle, Lancaster and Barrow and developing on the same site or next to midwifery-led units at Carlisle and Lancaster. This would mean the closure of the consultant-led unit at Whitehaven and the relocation of services to Carlisle. While the workforce challenges at Whitehaven are significant the report says that closure would create significant disruption for patients.
• Option 5 - Centralising all services in one unit. While prior to their visit the assessors felt this was likely to be a preferred option, because of the benefits that such a larger unit with 5,000 deliveries would have for women and their babies, given the geography involved they did not think that this option could realistically be developed further.

The report recognises that for NHS Cumbria CCG, and NHS North Lancashire CCG, recruitment is a real problem.

It also takes into account the geography of the area, and the travel difficulties of some people, like those in West Cumbria, if consultant-led maternity services were moved.

It says that if Option 1 is chosen, a project team should be established immediately, including an external senior manager, external obstetrician, head of midwifery and patient representatives.
The team would be accountable to the lead clinical commissioning group and would develop a detailed feasibility report on the cost, viability and risks of proceeding with Option 1. Local views and social deprivation would be important considerations.

The NHS Trusts now have to decide the best way forwards:

"We know how important maternity services are for the local population and the preferred option, Option 1, is consistent with the CCG’s commissioning intentions. However, these services need to be high quality, safe and sustainable and there is much work that needs to be done with both Trusts to overcome the significant challenges that they face.

“Clearly we will need to think about how we take into account the recommendations and any learning from the Kirkup report following the Morecambe Bay Investigation. We will also be sharing copies of the review report with Dr Bill Kirkup and with the team who will be carrying out the national review as announced recently by NHS England. We will also continue to talk to all local partners and the public.”

– Dr David Rogers, medical director of NHS Cumbria CCG

“We will now discuss the findings and recommendations with our Board and staff to understand their views and will work very closely with NHS Cumbria CCG as work progresses over the coming months on the recommendations.”

– Dr Jeremy Rushmer, medical director at North Cumbria University Hospitals NHS Trust

New Date for WCH hospital opening

As North Cumbria's acute hospitals emerge from a very difficult week, there is some good news: a date has been set for the opening of the brand new refurbished facilities, and £3.2 million of capital spend has been allocated, including a CT scanner and two mobile x-ray units (These will be delivered after the new power supply has been installed.)

The handover of the new hospital was delayed after a fire in January which destroyed the new energy centre. Fortunately nobody was hurt and the rest of the new hospital was undamaged.

A report to the NHS trust board, which met yesterday, stated that phase one of the project now looks set to be completed in October

More details on the News and Star website at http://www.newsandstar.co.uk/…/new-date-set-for-whitehaven-…

Cumbrian Hospitals stood down from "Major Incident" status

The Cumbrian NHS Trusts said today that the bed shortage crisis at Whitehaven’s West Cumberland Hospital and the Cumberland Infirmary in Carlisle has passed.

An internal major incident was declared at the two hospitals last week when they reached capacity.

All non-elective surgery was cancelled and some patients had to be treated outside the county. The trust which runs the cottage hospitals in Workington, Cockermouth, Maryport and Keswick opened extra beds in Maryport to help with the crisis.

A hospitals spokesman said: “Thanks to the collective efforts of all partners working together, the trust has now been able to successfully reduce the need to maintain escalation beds which was putting a major strain on staff and the ability to safely run services.

“Our focus now is on making sure that we learn from the events of the past week and also that partners continue to work effectively together so that all patients get the right care, at the right time and in the right place.”

Dr Jeremy Rushmer, medical director at North Cumbria University Hospitals NHS Trust, which runs the Acute hospitals, said:

“Patient care and safety has been our prime concern throughout this incident and we very grateful for everyone’s efforts over the past few days in resolving the immediate pressures facing hospital services.

“The pressures seen in recent weeks are a reflection of the scale and nature of much wider challenges across the entire health and social care system in north Cumbria and we continue to work collectively to ensure that any patients waiting unnecessarily in an acute hospital bed, are moved to the right care setting sooner rather than later.

“We would like to thank all staff for their effort and commitment during these particularly challenging times and also thank patients and the public for their co-operation.”

NHS Trust says bed shortage at WCH and Carlisle hospitals is easing

Hat tip to "@myhitehaven" on Twitter and the News and Star for the information that the Cumbria NHS authorities say the bed shortage is easing.

North Cumbrian University Hospitals NHS Trust - which runs The Cumberland Infirmary in Carlisle and Whitehaven's West Cumberland Hospital - declared an emergency on Thursday after running out of beds. Some patients had to be transferred to hospitals 75 miles away.

But the NHS group that controls much of the county's health spending - the Clinical Commissioning Group (CCG) - said the pressure on hospital beds has improved during the last 24 hours as officials worked to improve "patient flow" through the hospitals. A statement issued today said officials were still working to reduce the strain on the Trust’s ability to safely carry out its normal routine business while at capacity because patients were not "flowing through the system".

The statement said:

"All efforts are focussed on making sure this can happen as quickly as possible so that hospitals in Carlisle and Whitehaven can get back to routine business.

"Health and social partners are working to make sure patients who do not need to be in an acute hospital bed, are safely discharged to a more appropriate care setting or home with the right package of care.

"As usual, services are extremely busy over the weekend and the local health economy is calling on the public to play their part and use services appropriately."

The CCG urged people to:

* Think twice before using A&E or calling 999;
* To think about using other NHS services such as walk-in centres and pharmacies or call Cumbria Health on Call (out of hours) on 03000 247247 for advice on alternative urgent services available

 * Stay away from hospital if they have any symptoms of sickness or diarrhoea.

A CCG spokesperson added:

“A tremendous effort has been made by all partners so that the Cumbrian health system can provide support and assistance during this incident and these efforts have shown the robustness of the system in coping in times such as these.

"However, this does not mean we are complacent and we will continue to work together to ensure the situation continues to improve.”

Joint statement from NHS organisations in Cumbria

A joint statement has been issued on behalf of the NHS in Cumbria about the issues at the hospitals today.

All non-urgent elective operations have now been cancelled today and tomorrow at both the Cumberland Infirmary in Carlisle and the West Cumberland Hospital in Whitehaven.

The statement refers to difficulty admitting and discharging patients, long waits in the emergency department and high numbers of patients in acute hospital beds awaiting discharge as the reasons for the crisis. It goes on:

"To help alleviate these pressures, NHS organisations across north Cumbria have jointly agreed to categorise the current situation as an internal major incident, in order for the hospital trust, NHS Cumbria Clinical Commissioning Group (CCG), Cumbria Partnership NHS Foundation Trust, ambulance services and the local authority to divert resources, to ensure patients get the best possible care."

A spokeswoman for North Cumbria University Hospitals NHS Trust said that the declaration is across the trust, but the Carlisle hospital is more acutely affected.

Dr Jeremy Rushmer, medical director at North Cumbria University Hospitals NHS Trust, said:

“Our prime concern is making sure we can continue to provide safe care for patients and this becomes increasingly difficult when our hospitals reach capacity.

"Given the continued and significant pressures our teams have faced over recent months, our hospitals are now struggling to admit any more patients until we can get patients flowing through the system and into appropriate community settings or home with the right package of care.”

Dr Hugh Reeve, interim chief clinical officer for NHS Cumbria CCG, said: "Frontline teams are extremely busy and we would urge people to think twice before using A&E services or calling 999 which should only be used for serious life threatening emergencies."

Joanna Forster Adams, director of operations at Cumbria Partnership NHS Foundation Trust, said:

 “We have been working closely with all partners in the health and care system as part of the joined up response to this situation for a number of weeks.

"We have taken further actions today to create as much capacity as is safely possible including opening up a small number of additional beds in community hospitals.

"We would like to thank our staff who have been working create additional capacity and support in all our services‎ and would like to thank staff and patients who have been affected by changes in recent weeks.”

A North West Ambulance Service NHS Trust spokesman said:

“The trust is working closely with healthcare partners to manage the issues at North Cumbria Acute Hospital Trusts.

“Patient care and safety is always our priority and we will continue to work with partners to ensure continued focus on safely transporting patients who need to go to hospital.”

Major Incident declared at Cumberland Infirmary and affecting WCH

The News and Star website reports this morning that a major internal incident has been declared at north Cumbria's hospitals by the Trust in charge of the Cumberland Infirmary in Carlisle and the West Cumberland Hospital.

 

The News & Star has learned that staff were called to a meeting at 3pm yesterday, at which they were told that the hospital is now at "escalation number five", which is an internal major incident.

A spokeswoman for North Cumbria University Hospitals NHS Trust told the News & Star that the declaration is across the trust, but the Carlisle hospital is more acutely affected.

The News and Star says that the hospital simply ran out of beds yesterday afternoon, and had no option but to declare an emergency and call for help from its partner agencies.

A full statement from the trust and HS Cumbria Clinical Commissioning Group is expected later.

Maternity report delayed

Publication of a controversial report into maternity services as West Cumberland Hospital has been delayed.

 

An independent review by the Royal College of Obstetricians and Gynaecologists into maternity services throughout Cumbria had originally been expected to be completed by the end of February, but it is now thought likely to be finished in March.

 

A spokeswoman for NHS Cumbria Clinical Commissioning Group (CCG) said:

“We had thought that the report may have been completed in February but such reviews are complex and we are grateful to the Royal College for doing this for us.

“Following consideration of the report by the CCGs it will be shared with all interested parties including the public. We would like to stress that we understand the high level of interest in this report and would wish to make it available as soon as possible.”

She added: “We commissioned the report to provide independent, objective and expert clinical advice to support the local NHS in making the best and safest possible decisions about future arrangements for maternity services.

“In considering the report we will of course we taking into consideration the findings of the Report of the Morecambe Bay Investigation. We will also be taking a close interest in the national review of maternity services that has been announced by NHS England.”

For more details see the Cumberland News website at
http://www.cumberlandnews.co.uk/much-anticipated-maternity-services-report-delayed-1.1196959

Changes to outpatient services at WCH and Carlisle

North Cumbria University Hospitals NHS Trust has made substantial changes designed to improve care provided by outpatients service at  the Trust’s two hospital sites – the Cumberland Infirmary and West Cumberland Hospital, as well as clinics held at Workington Community Hospital. The service provides a quarter of a million appointments each year.
    
The Trust says that service is now delivering more consistently safe and responsive care since addressing issues identified by the Care Quality Commission (CQC) inspection in May 2014, which resulted in the service being rated as inadequate.
   
Nick McDonaugh, deputy director of Emergency Surgery and Elective Care, said:

“The response from staff has been exceptional since the Chief Inspector of Hospitals’ report last year and progress has been made not just within the outpatients service but across the whole Trust.

“By overhauling our processes and putting a number of short, medium and longer term initiatives in place since last summer, we are now seeing patients receive a more consistently safe and responsive approach to care. This would not have been possible without the unwavering support and commitment of our staff right across the board.”

The cornerstone to this achievement is the availability and completeness of medical records for outpatient appointments. The Trust is working hard to ensure the completeness and quality of all medical records continues to improve. Part of the CQC inspection involved an audit of case note availability – an individual patient’s medical history to support the doctor or consultant to deliver effective healthcare during clinics.
    
Only 72 per cent of medical records were available on the day of the clinic during the inspection in April 2014 but since then major improvements have taken place thanks to a number of changes identified by a weekly outpatient improvement group.

Since December 2014 clinics at West Cumberland Hospital and Workington Community Hospital have consistently achieved a minimum of 95 per cent case note availability at the start of clinics. The Cumberland Infirmary is also now consistently achieving the target of 95 per cent availability. As a result, only two outpatient appointments have been cancelled since the beginning of December 2014 due to issues around case notes.

The improvement in availability is due to processes being put in place to improve the timely transfer of medical case notes between the Trust’s hospitals, improving the transfer of case notes between departments at least seven days before the outpatient clinic occurs, and delivering systemised and categorised access to case notes.

Nick added: “We are now focussing on maintaining the high standard, ensuring more clinics are running on time and that there are fewer cancellations. We are all committed to improving our patients’ overall experience.”

There are many excellent staff at our local hospitals and I know the trust is quite right when it says they are all working hard to deliver better care. If anyone reading this has had experience of a recent outpatient appointment and would like to leave a comment - positive or negative - I'd be most interested to hear it.