Chorley A&E closure consultation is scrapped
Chorley and South Ribble Hospital’s accident and emergency department is set to remain open for the foreseeable future, after the health secretary ordered that a planned public consultation solely recommending its closure be scrapped.
The Post understands that Matt Hancock made the eleventh-hour intervention not long after local NHS bosses had been told that they could finally set a date to formally ask residents for their views on the future of the facility.
That would have been the culmination of a tortuous process which goes back almost five years to when the A&E at the Euxton Lane site was shut down for nine months because of a shortage of medics.
As the Post revealed just over a year ago, the two main options likely to be put to the public involved the closure of the now part-time department and its replacement with one of two versions of a round-the-clock urgent care centre. Several groups of clinicians drafted in to assess the situation had concluded that the facility was not “clinically viable”.
The option of sticking with the status quo was still set to make it to the shortlist, but only to provide a benchmark position against which the proposed alternatives could be judged.
However, the Post can now reveal that, just over a fortnight ago, the head of NHS England in the North West wrote to local health leaders to tell them that Mr. Hancock had issued “an instruction...to develop an option that provides safe, high-quality care and continues to include Chorley ED [emergency department]”.
Central Lancashire's two clinical commissioning groups (CCGs) have confirmed that they will now be abandoning altogether a consultation that was the pivotal plank of the Our Health Our Care (OHOC) programme, which was set up in 2016 to reconfigure health and social care services in the region.
The long-term future of Chorley A&E will now be explored as part of work to assess the development either of two new hospitals to replace the Royal Preston and Royal Lancaster Infirmary, or a so-called “super hospital” to serve the whole of Central and North Lancashire.
Those options were unveiled by the Department for Health and Social Care (DHSC) late last year when funding was announced for a series of new hospital builds across the country. However, it could be anything between seven and 10 years before any new such facilities are built.
The area’s three MPs stepped up their collective lobbying of the health secretary over the future of Chorley A&E when it was once again shut completely for eight months last year as part of plans to increase intensive care capacity to deal with the pandemic.
Last spring, Matt Hancock made a number of asides on the subject in Parliament when addressing Chorley MP and Commons speaker Sir Lindsay Hoyle - on one occasion, telling him that he was a “huge enthusiast” for the department.
Responding to Mr. Hancock’s blocking of the consultation in its proposed form, Sir Lindsay welcomed the abandonment of what he described as a process “skewed towards justifying the closure of our A&E on a permanent basis”.
“Chorley has an expanding population and needs a fully-staffed, fully-functioning A&E department at our local hospital.
“I and many residents have campaigned for our A&E to remain open on a number of occasions when the trust has decided to close its doors. Thankfully, we received a return to 12-hour provision, although I want to see this extended and will continue to lobby for 24-hour [opening],” Sir Lindsay said.
South Ribble MP Katherine Fletcher said that the issue is one of the most common raised with her when she speaks to people in her constituency.
She added: “The three MPs have worked hard to ensure the health secretary really understands the detail and I am pleased that he has not only listened, but personally involved himself at a time when his diary isn’t exactly quiet.”
Ribble Valley MP Nigel Evans hailed a “very sensible decision” which would give the people served by Chorley A&E - including those in parts of his own constituency - “the service they deserve”.
The letter to local NHS bosses, which outlined Mr. Hancock’s instruction to halt the consultation as it stood, was sent by NHS England North West (NHSE NW) regional director Bill McCarthy.
In it, he stated that the move had come about because of “deep concern at the way the process has been managed so far, as public confidence in the process is not where it needs to be”.
He added that the work done to date had “focused on the closure or downgrading of the ED at Chorley” and there was a lack of confidence “that sufficient consideration has been given to how a safe, high-quality service could be offered to local people while retaining [the department]”.
However, the Post understands that what is known as the “assurance process” NHSE NW had undertaken, assessing the work to develop options, had given the consultation a provisional green light just last month.
A source has told the Post that having initially offered “partial assurance” in early January, NHSE NW then gave “full assurance” a month later after its initial minor concerns received a response. It would then have been considered at a national NHS level.
The decision to reopen the facility back in November - just as the second wave of coronavirus began to hit the region - sparked anger from emergency department consultants at Lancashire Teaching Hospitals (LTH) , which also runs the Royal Preston. Seventeen of them wrote a letter describing the reopening as “misguided and dangerous”.
Since that date, the unit has been open between 8am and 5pm, seven days a week - although the latest developments will see bosses consider how they can restore the 12-hour service that was in operation from January 2017 until last March.
The OHOC work has been carried out by existing CCG and LTH staff as part of their normal duties - although the partnership does have a dedicated programme director.
It is understood that this work will now be used to form the basis of the business case being developed as part of the new hospitals programme.
WHAT HEALTH BOSSES SAY
A Department for Health and Social Care spokesperson said: “Any NHS service reconfigurations must follow the proper processes, including undertaking appropriate stakeholder engagement and consultation. We expect local partners to work together to ensure safe and efficient services are accessible for all.”
An OHOC spokesperson said: “The NHS in Lancashire is committed to safe, convenient and high quality services for patients. In emergency departments that is especially important. That’s why over the last few years we have sought to find new ways of making hospital services better.
"Following correspondence from NHS England and NHS Improvement (North West) reflecting direction from the Secretary of State for Health and Social Care we have taken the decision to stop the planned OHOC consultation.
"Instead, the Lancashire and South Cumbria Integrated Care System, where all the local NHS organisations work together have decided to make hospital services better through the Government’s New Hospital Programme.
"This is a sensible way forward as it reflects the new options available to the local NHS through the New Hospital Programme which were not available when the OHOC programme began.
"As part of this work, we have been asked to fully consider options that provide safe, high-quality care, within Chorley Hospital’s emergency department.
"The CCGs and Lancashire Teaching Hospitals NHS Foundation Trust are working together with other partners to ensure we are in the best place possible to take advantage of this significant opportunity to deliver long-term benefits for local people.
"In the meantime, Lancashire Teaching Hospitals NHS Foundation Trust and the CCGs are working to restore the provision of emergency services at Chorley emergency department to the commissioned service model.
"We continue to engage regularly with Lancashire County Council and its Health Scrutiny Committee.
"As you would expect with these and other matters, the NHS will continue to support service models which are safe, effective, and put patients first. This isn’t just what is in our statutory obligations, it’s what’s right.
"We are confident that this is the right way forward and we will keep you updated on next steps."
NHS England North West was also approached for comment.
LETTER TO LANCASHIRE NHS LEADERS, dated 11th February, 2021
Thank you for the work the system has developed in relation to the Our Health Our Care programme which includes options for Chorley ED [emergency department].
We have received an instruction from both the secretary of state for health and the minister of state for health to work with the ICS [integrated care system] and local leadership to develop an option that provides safe, high-quality care and continues to include Chorley ED. This would also include setting out what it would take to achieve this.
This has been based on the following reasons:
***Deep concern at the way the process has been managed so far, as public confidence in the process is not where it needs to be.
***Concern that the work that has been done to assess the clinical issues has focused on the closure or downgrading of the ED at Chorley.
There isn’t confidence that sufficient consideration has been given to how a safe, high-quality service could be offered to local people while retaining the ED at Chorley. This needs to be fully considered to enhance public confidence.
It is important to recognise that the views of the ICS [integrated care system] leadership on the matter of patient safety have been noted.
Local stakeholders should be informed this work has been requested - therefore, there will be no further discussion or prospect of closure of Chorley ED until a new set of options has been developed.
An urgent response is required considering the timing of the development of the ICS case for change and clinical strategy in support of the new hospital programme of work.
We would be happy to meet with you to discuss how you will take this forward.
North West Regional Director, NHS England and NHS Improvement
This is how the story of Chorley and South Ribble A&E has developed over the last five years:
April 2016 The then 24-hour department closes due to a shortage of six out of the 14 middle-grade doctors needed to staff it.
January 2017 The unit reopens for 12 hours a day.
July 2018 Informal engagement events are held with the public over issues including the future of Chorley A&E
August 2019 Thirteen nuanced options published for the future of the facility, which local NHS commissioners are charged with whittling down, after a group of medics concludes the facility is not “clinically viable”.
January 2020 Shortlist of three suggested options published for proposed public consultation - the two main ones recommend closure of Chorley A&E and replacement with urgent care centre.
March 2020 Facility closes as part of plan to tackle the pandemic in Central Lancashire.
November 2020 Unit reopens for nine hours a day.
February 2021 Health secretary orders any consultation must include option to retain Chorley A&E . Local NHS bosses halt consultation process and decide to explore the long-term future of the facility as part of work to investigate new hospital builds in the region.