A report going to County Hall tomorrow will tell councillors that the most patients can hope for is a 12 hours a day A&E service from mid-January, backed up by a 24-hour Urgent Care Centre.
The “temporary” closure of Chorley’s A&E in April has led to months of campaigning by residents and local politicians for a total reinstatement.
But Lancashire Teaching Hospitals NHS Trust will rule that out when it delivers its response to 10 recommendations made by the county council’s health scrutiny committee “Reinstating the emergency department 24 hours a day is not currently realistic,” says the Trust.
In September the committee, which blasted the Trust for its handling of the closure, made 10 recommendations towards the restoration of the service. Here is what health chiefs have said in response.
1. Councillors demanded “a transparent, sustainable, realistic and achievable plan” for the provision of services at Chorley.
The Trust has responded by saying it is “fully committed” to reinstating the emergency department. But it adds: “We are working towards re-opening on a limited hours basis (12 hours a day) on January 18 when the new 24/7 integrated Urgent Care Centre opens.
“It has been agreed that it would not be practical or safe to re-open the department before this date, as it would compromise the major trauma centre at the Royal Preston Hospital. Furthermore the independent review, jointly commissioned by NHS England and NHS Improvement, concluded that it is not feasible to re-open the department on a 24-hour-a-day basis.”
It also says it has a “focused recruitment plan” to secure additional staff.
2 The committee asked the Trust for details of how they are addressing their “inability” to meet the four-hour target for A&E attendance at Preston.
In their report the health chiefs say the problem is a national one with only four of the 138 large A&E departments in the country meeting their target of seeing 95 per cent of patients inside four hours.
“The Trust’s aim is to ensure that all patients are seen, treated or discharged within four hours and we are committed to the national A&E improvement programme. The Trust, however, has to prioritise seeing those patients that require urgent treatment for serious or life-threatening conditions and, at times, this can create delays for those people who are less seriously ill.”
The Trust says it is working closely with the Clincial Commissioning Groups and a new provider to mobilise a new 24/7 urgent care service at both hospital sites which should help reduce the pressures on RPH, allowing A&E staff to be freed up to focus on the most acute cases.
3 The CCG was asked to provide the committee with evidence that is is supporting the Trust to explore all methods to recruit and retain staff.
The response is that the CCG is “satisfied” the Trust have explored all of the options available to them.
The Trust has undertaken a proactive, comprehensive recruitment drive, both nationally and internationally. Job roles have been revised to make them “more attractive to potential candidates. Recruitment processes have also been improved to enhance the speed in which CVs are considered and also the process of arranging interviews and finalising job offers.
It says since April more than 150 CVs have been recived and 12 job offers made - although to date all those applicants have declined the offers.
4 The committee recommended that NHS England undertake a review of the national issues identified within the report, such as locum pay, the removal of the agency cap and the number of emergency medicine trainee places.
On that point the Trust says: “We are unable to comment on this.”
5 On the question of the Trust’s “failure to communicate in a timely and effective manner with the public”
The committee recommended that NHS commissioners be asked to demonstrate how they will “effectively engage and involve local residents in future.”
The response of the Trust is that it recognises there was “very little notice given to the public” before the A&E department at Chorley was closed due to safety concerns. A revised communications and engagement plan has now been put in place.
6 The committee felt a plan should be developed to identify the lessons learnt from the situation.
The Trust says the CCGs “will assess the review and see if any further reviews to inform lessons learnt are
7 A plan for emergency care across Lancashire should be developed as a key priority, said the health scrutiny committee.
The Trust’s response is: “Urgent care is a work stream and a priority within the the Lancashire and South Cumbria Sustainability and Transformation Plan, which is now publicly available.”
8 The committee recommended that prior to mid-January the Trust should make “every effort” to increase the urgent care centre opening hours on the Chorley site to 6am-midnight as additional staff are appointed.
The Trust says the interim measures at Chorley (8am - 8pm) are in place to provide cover while the temporary closure of the A&E department is in place.
“Last year the local CCGs ran a tender process for a new 24/7 integrated urgent care service. The new urgent care provider will bring extra staff to the system , which gives more opportunity to reinstate the emergency department.”
It adds that extra nurses and consultants are being recruited and consultants have agreed to work extra shifts to help reinstate the service.
“The Trust is therefore focusing on the re-opening of the emergency department on a limited hours basis (12 hours a day) on 18 January when the new 24/7 urgent care centre opens,” it says. “The emergency department will continue to treat injuries and more serious conditions that the new urgent care centre cannot treat, so we still expect to see a significant number of patients.
“It is not practical or safe to re-open the department on a 6am to midnight basis as it would require both additional staff and existing staff to work excessive hours.
“The independent review commissioned by NHS Improvement and NHS England recognises that reinstating the emergency department 24 hours a day is not currently realistic.”
9 The committee urged the Trust to “actively seek best practice from other Trusts regarding staff on A&E.”
The response is: “The Trust does this on a regular basis. The Trust is always open to looking at new ways of working and best practice and will continue to welcome this input from other organisations and advisors.”
10 The final recommendation from the committee was that “a more open approach to design and delivery changes to the local health economy needs to take place to make our hospitals more sustainable and better able to serve the needs of resident.”
The Trust says in reply: “All of the health and care organisations within the central Lancashire economy are committed to fully engaging with the public and wider stakeholders about any planned service change.
“However it is important to note that the temporary change to the A&E department at Chorley was necessitated by a culmination of unpredictable events. This difficult decision was taken to keep patients safe.”