A meeting of NHS leaders which was called to whittle down more than a dozen options for the future of Chorley and South Ribble Hospital’s A&E unit has resulted in them all being kept on the table for further investigation.
The joint committee of the Greater Preston and Chorley and South Ribble clinical commissioning groups (CCGs) also voted to make a fresh call to government to determine whether there is any possibility of funding being found for a so-called “super hospital” in Central Lancashire. That long-discussed plan would see a new facility built on a single site to replace both the Royal Preston and Chorley hospitals.
Members of the GP-led gathering were presented with a recommendation to reduce a total of 13 proposals down to eight. That would have seen the option of maintaining the existing 12-hour A&E service at Chorley ruled out, along with several suggested redesigns of the way pre-planned surgery is split between the Royal Preston and Chorley sites.
But the committee instead voted to carry out more detailed work on all of the options - including the reinstatement of a round-the-clock A&E facility and proposals to downgrade it to one of two versions of an urgent treatment centre.
Several members expressed concern that any of the options should be ruled out before a more rigorous assessment of each of them had been completed.
Preston CCG lay member Ian Cherry said that separate plans to overhaul out-of-hospital services also needed to be more “clearly linked” to whatever may be decided about the future of acute care. Papers presented to the committee revealed that all the options were predicated on a forecast five percent reduction in an A&E attendances and a two percent fall in non-emergency admissions in the region.
“These are important assumptions [the evidence for which] needs to be tested before we make any decision,” Mr. Cherry said.
Jason Pawluk, programme director for the Our Health Our Care initiative - which is carrying out the work to reform urgent and emergency care services in Central Lancashire - said that the enhanced scrutiny now being proposed would address that issue.
“It will assure us whether these are the right range of options, developed for the right reasons and likely to generate better clinical outcomes,” Mr. Pawluk said.
The full list will now be subjected to “enhanced clinical scrutiny” from a broader range of local primary and secondary care clinicians than has been the case so far - and will then be considered by a similarly-constituted group from outside Lancashire, known as an “NHS Clinical Senate”.
The options will include a so-called “do nothing” approach, which had initially been included as a way of comparing any of the proposals to the current set-up - but which one member said should also be considered in its own right.
“If what we have to offer is worse [than the current arrangements], then doing nothing is the right thing to do,” said Chorley and South Ribble CCG chair Dr. Gora Bangi.
“I want to know what the difference is between sitting in a room and saying we can change a particular [service] and actually redesigning it on the ground - [because] the consequences can be people’s health.”
The meeting heard that it had not been possible to include a super hospital as one of the formal options - because only proposals which had the necessary funding attached could be taken forward. But several members said that such a plan should not be “written off”.
“If you don’t ask, you don’t get,” said Paul Richardson, vice chair of the two CCGs.
The Local Democracy Reporting Service revealed last week that an unpublished feasibility study in 2016 into a single-site hospital to replace both the Royal Preston and Chorley hospitals was the “preferred approach” of local NHS leaders - but that funding had never been secured for their plan A.
“How far adrift is plan B [the current list of options] from plan A?” Chorley CCG lay member Linda Chivers asked.
“I need to know that before I can decide whether any of the options are suitable.”
A Preston CCG lay member, Debbie Corcoran, also warned that the local NHS could be “disadvantaging our communities by not progressing options which require a capital element”.
The committee supported a suggestion by chief officer Denis Gizzi to approach the Treasury, via NHS England, with a “formal request” for funding for a single-site hospital in Central Lancashire. The bid would be made in parallel with the process to determine the most suitable option which does not require significant capital investment.
Dr. Bangi told members of the public in the audience that the committee were not “nodding dogs” - a charge often levelled by the Protect Chorley Hospital campaign group.
“This is not an easy task and it’s important that the public understands that we currently have an unsustainable health economy in this area,” he said.
But one campaigner, Cathy Hurley, told the dozens of others who had attended the meeting that they had “had an influence by their presence”.
Another addressed the committee as the meeting broke up: “You are yet to convince us of the fact that you are doing the right thing,” he said.
Chorley MP Sir Lindsay Hoyle, who was also present, said the “elephant in the room” was the fact that there is “not enough money” for the NHS in Central Lancashire.
“Where is the evidence to say that an A&E at Chorley is not sustainable?” he asked.
“If you start off down this road of reducing services at that hospital, there will be no turning back.
“So it’s important that the people on this committee who will be making the decisions hold their nerve and do not fall into the trap which has been set for them,” he added.
The committee also approved a plan to carry out an analysis of the impact of any changes to non-emergency NHS services on the time which patients have to travel to reach their appointments.
It followed an intervention by a member of the public who interrupted the meeting to hand out a document detailing case studies of the adverse effect of introducing community-based services for people with transport and mobility difficulties.
Speaking after the meeting, Louise Paj said: “Services which are taken out of hospital are often moved into local GP surgeries which are not always accessible from other [parts of the region].”