Work to draw up a shortlist of options for acute care in the region has been taking place in recent months as part of the Our Health Our Care (OHOC) programme.
The outcome of the process - which is designed to ensure that the sector is sustainable - is likely to determine the future of the part-time Accident and Emergency unit at Chorley and South Ribble Hospital. If major changes to services are ultimately proposed, they will have to be put out to public consultation.
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The shortlist is set to be discussed at a public meeting of the joint OHOC committee on 28th August, but the governing bodies of Greater Preston and Chorley and South Ribble Clinical Commissioning Groups (CCGs) have been told that the work to date requires a greater contribution from medical professionals.
Thirteen possibilities had been assessed and whittled down to six, but now a broader set of options are back on the table.
“The view is that the work so far has been okay, but okay is not good enough to take it to the next level,” Denis Gizzi, chair of the two CCGs, told a meeting of the governing body for Greater Preston.
“If we feel that the options are not quite there, then we have to bring them all back in for review - and even look at new ones.
“Timescales are now quite tight and senior clinicians will have to come together...to look at some quite complicated things.”
The shortlist is due to be considered by independent medics from elsewhere in the North West in mid-September before being examined by NHS England in December. National NHS bosses have to be satisfied with the process before the final list of options can be presented for formal public consultation, which is expected to take place early next year.
But Dr. John Cairns, a GP director on Chorley and South Ribble CCG, told a meeting of that governing body that an acknowledgement of Chorley’s ballooning population was “massively missing” from the conversation.
“The population of the borough rose from 97,000 in 1991 to 116,000 this year and is estimated to increase by another 18 percent [in the 25 years] up to 2039. The estimated growth in households in Chorley over the next two decades is the largest in Lancashire.
“The idea that we are assessing options [which could] downgrade a hospital that already serves an area of this size is incredibly short-sighted.
“We can get carried away with the management speak, but I thought it was worth reminding people of that fact,” Dr. Cairns added.
'WE HAVEN'T GONE BACKWARDS'
The chair of Central Lancashire’s two CCGs has denied that the plans for the future of urgent and emergency care in the region are less developed than they were this time last year.
Denis Gizzi said the process had to go “back to basics”.
A draft “model of care”, produced under the OHOC umbrella last August, suggested that the public would be presented with a proposal for a single A&E unit for Central Lancashire, the retention of two urgent care centres and the creation of a “ringfenced” facility for pre-planned operations. No specific locations were identified.
But when the OHOC joint committee agreed the final model in March this year, reference to the numbers of individual facilities had been removed. Plans for a public consultation in January were also put back by twelve months.
“To take through really complicated changes, you have to go down the due diligence route and take it in logical chunks", Mr Gizzi explained.
"There was a view that, prior to the most recent iteration of OHOC with the joint committee, we hadn’t quite gone through those stages - so it wouldn’t have passed muster.
“The pre-engagement with clinical professionals had to be done - so it wasn’t wasted time - but it can’t be seen to come out with a predetermined outcome. You then have to start the process proper at that point.
“When you go through these processes, you have to keep an open mind - you can’t start out and say the obvious answer is X and then just go through the process to come to answer X - that’s not permissible.
“The next stage is how you consider all the different permutations of options to achieve [your] model of care. It’s intensely complicated and we’re aiming to get that shortlist of options described [by late August] - but there will be no decision around which site will have X and Y.
“Then there’s the doability factors. Lots of people can describe the best health and care services in the world as they relate to hospital services, but we might not be able to do that within the resources we’ve got.
“We’ve got to find a range of options that are clinically and economically grounded,” Mr. Gizzi added.
Gary Raphael, executive director of finance at Lancashire and South Cumbria's Integrated Care System, told a recent meeting of the county's health and wellbeing board that there are likely to be "some big changes to acute services" in the region.