Consultation into future of Chorley A&E could begin by autumn

It was announced earlier this week that NHS bosses are working towards restarting the service sometime that month, after it was temporarily closed back in March as part of the local response to the coronavirus crisis.

However, while its short-term prospects are now more certain – provided Lancashire does not witness a second spike in Covid cases – the long-term prognosis for the unit remains far from clear.

Prior to the current pandemic, it was expected that the public would be formally asked for their views on the future of the A&E this summer. That process was derailed by the coronavirus outbreak, but the Local Democracy Reporting Service can reveal that the work underpinning it is poised to restart this month.

That means that the consultation itself could begin in the autumn at the earliest. It would run for 12 weeks – being paused for a fortnight if it were to straddle the Christmas and New Year period.

Back in January, it emerged that two of the three likely options to be put forward recommended the permanent closure of the unit and its replacement with one of two versions of an urgent treatment centre. The third proposal – retaining the status quo of a part-time A&E – would be included simply as a benchmark for comparison.

That option – along with the resumption of a round-the-clock service – were both deemed not to be clinically viable by medics from Lancashire and across the North who were drafted in to examine the situation.

Jason Pawluk, delivery director for the Our Health Our Care (OHOC) programme, says that the move towards a September reopening does not “fundamentally alter” the clinicians’ earlier conclusions.

“We still need to have an honest conversation with the public about the best long-term solution for A&E and critical care hospital services.

“We’re keen to avoid anybody forming a view that this is the first step towards a 24/7 A&E or restoring a type 1 A&E facility [the most extensive] at Chorley.

“There are still real questions to answer about long-term viability and the most appropriate care model,” Mr. Pawluk said.

In order to reopen safely and separate Covid and non-Corvid patients, Lancashire Teaching Hospitals NHS Foundation Trust (LTH) will have to make structural alterations at the Chorley site and recruit additional staff – funding for both is now being sought from NHS England. It was staff shortages that forced the closure of the unit for much of 2016 and have dictated its part-time status since.

Mr. Pawluk says that OHOC – a group of organisations overhauling health and social care services in Central Lancashire – is committed to an “open, fair and transparent consultation”, which listens to everybody’s views.

However, two scenarios for that process are currently being drawn up to reflect the fact that any consultation is likely to be conducted during an ongoing pandemic.

“It may be possible to do public engagement events and discussions in socially-distanced [situations] – such as workshops and focus groups.

“But we’re also looking at mitigation, whereby if the public health context changes and becomes more difficult, we can take more online and digital approaches.

“We want to do the former, but we are prepared to do the latter – while if things get very bad again in relation to Covid, we would reflect on whether now is the right time to do a consultation,” Mr. Pawluk said.

He added that OHOC had used the lockdown period to engage with the public via its social media channels about the consultation process to come, as well as to design some of the materials which may be used.

Critical care facilities were also closed at Chorley Hospital when the A&E shut in March. It is understood that there will be a phased approach to their reopening, initially providing the necessary cover to treat, assess, and stabilise patients with critical care needs in Chorley before transferring them to the Royal Preston when appropriate.

Denis Gizzi, chief accountable officer for Central Lancashire’s two clinical commissioning groups (CCGs), said it was important to restore services “wherever this can be done safely” – with plans also being developed to increase pre-planned care at both hospital sites.

“However, we are also clear that our local hospitals, without change, continue to face significant workforce challenges which will make it difficult for them to deliver essential quality standards for patients in the long-term.

“Over the past few months, health and care colleagues from across community, primary and secondary care have delivered outstandingly, and in unprecedented circumstances,” Mr. Gizzi added.

MPs’ REACTION

Chorley MP Sir Lindsay Hoyle said that while he welcomed the news of a September reopening for the town’s A&E, “the OHOC plans still place its future under threat”.

He said that he would once again be lobbying health secretary Matt Hancock to secure a long-term commitment to keeping the unit open.

Meanwhile, he blasted the idea that any public consultation could be carried out while Covid-related restrictions were in force.

“If this does go ahead, it needs to be as full and accessible as possible – and if this cannot be done by including everyone who wishes to contribute, then it should not take place.

“Having a consultation which can’t be conducted in public in the normal way isn’t a genuine consultation – and relying on online sources only does not always facilitate everyone having their say, so I’d be totally opposed to it in the current environment,” Sir Lindsay added.

South Ribble MP Katherine Fletcher said she understood why OHOC would be worried that people may see the forthcoming reopening as a longer-term commitment, but added: “That’s exactly what is needed.”

“I’m not necessarily talking about the instatement of a full trauma centre, but we certainly need acute A&E services, 24/7. We [the local MPs] don’t believe that staffing is the issue, we think it’s a lightning rod for a pre-made decision.”

However, she described the contingency plans being put in place for the type of consultation that may be possible by autumn as “pragmatic, because we’re not through this awful virus yet”.

CHANGED TIMELINE

Before a public consultation can begin, the proposals on which it is based must be approved both by NHS England and the local clinical commissioning groups (CCGs).

A joint committee of the Chorley and South Ribble and Greater Preston CCGs had been due to take place in March, at which the GP-led group would have decided whether or not to agree the options to be put to the public – before referring it to national NHS bosses for their consideration.

Coronavirus caused the cancellation of that local gathering and it has now emerged that NHS England has since requested that it be allowed to conduct its own assessment first, before the matter is passed back to the joint CCG committee.

The Local Democracy Reporting Service understands that NHS England is likely to begin examining the documentation later this month.

Meanwhile, Lancashire County Council’s health scrutiny committee – a cross-party group of councillors from both County Hall and the district authorities – can also have its say on the process. A planned discussion in February was abandoned after time ran out for a presentation from local NHS leaders – although the papers to be considered were already in the public domain for members to see.

It is understood that the committee’s privately-held steering group has recently been briefed on work undertaken since then and it will be up to the committee whether it requests a formal presentation and an item on the agenda at any future meeting before the consultation begins.

WHAT THE CLINICIANS SAID

Last year, four groups of clinicians were commissioned to assess the then 13 options put forward for the future of Chorley and South Ribble Hospital.

Their conclusions – including those of the Royal College of Emergency Medicine (RCEM) – reveal the scale of the challenge that they believed was facing the NHS in Central Lancashire.

While the medics agreed that consolidation of emergency services onto a single site in Preston would ease staffing pressures, they warned that the move would lead to “longer travel times for some patients, with uncertain impact on a small proportion with high acuity problems”.

The RCEM report also described the current Chorley A&E as “a safety valve” for the Royal Preston.

“The Preston site would struggle to cope with the workload were emergency medicine and acute/general medicine services to be moved to that site. This is because of the quality and configuration of the estate and the current difficulties with patient flow,” it said.

The medics also said that staff had told them during a visit last April that they felt that “they have been asked to adopt a current model with which they do not feel comfortable, at least partly as a result of political and public reactions to a previous downgrading of the emergency department] at Chorley”.

Meanwhile, an NHS North West Clinical Senate report acknowledges “the commitment and dedication of staff” for keeping the current arrangements sustainable for as long as they have been and for innovations in working across the two sites..

“Staff are providing excellent services – and this is a credit to them,” the senate report states.

All of the reports express varying levels of concern that local NHS leaders are placing too much faith in the capacity of ongoing moves to expand primary care and community services to be able to alleviate the strain being felt by hospitals. RCEM describe the hope that it can help manage demand as “wishful thinking”.

The government’s recent promise of “seed funding” to help draw up a business case for a new single-site hospital in Central Lancashire was also dismissed as being too distant a prospect to justifying pausing the more immediate plans for an overhaul of NHS services in the region. A local clinical oversight group ranked it as one of their most-preferred options, but several members acknowledged that any new build facility – should it materialise – is expected to be at least a decade away.

WHAT’S THE DIFFERENCE?

Out of the two versions of an urgent treatment centre (UTC) recommended for inclusion on the shortlist, the first is known as an “enhanced UTC”.

It would be open 24 hours a day, but staffed by an “acute medical senior decision-maker” for half of that time and GP-led during evenings and overnight. There would also be an ambulatory care unit focused on treating patients without the need for them to be admitted.

The second UTC option would also be a round-the-clock facility, but staffed by GPs only. It would treat a slightly wider range of minor injuries and ailments than the existing UTC at Chorley.

Under both options, Chorley would lose its critical care unit, which the NHS North West Clinical Senate says is one of the most under-utilised such facilities in the country. The Royal Preston is currently extending its critical care facilities and is also the region’s major trauma centre.

The Chorley site would instead become the focus for routine, pre-planned surgery in Central Lancashire – providing an enhanced care unit for post-op recovery.

Speaking in January, Jason Pawluk, delivery director for the Our Health Our Care programme, said the facility would be classed as a “centre of excellence”.

“The rationale is to maximise the available utilisation of the trust’s theatres, its beds and critical care facilities. The view is that by [converting] Chorley into an elective centre and making Preston more of a medical centre, you’d be allowing the trust to manage overall activity better.

“That would improve elective times by reducing cancellations, improving access and patient experience.”

Mr. Pawluk said that the potential changes would cause only “a small proportion of patients” to travel further than they do now for treatment.

“Just looking at urgent and emergency care, 89 percent of patients would still be able to get their care at Chorley [under the enhanced UTC option], so only 11 percent would be affected. That figure is slightly lower for the GP-led UTC service at 84 percent.

“Looking at all emergency and elective patents together, 96 percent would either be the same or better off [in terms of distance travelled for treatment]."