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Home > News > North Cumbria outlines thinking on future clinical options

North Cumbria outlines thinking on future clinical options

Posted on Friday 24th October 2014
Larch AB

North Cumbria University Hospitals NHS Trust has today outlined its early thinking and an initial ‘clinical options appraisal’ to help ensure the delivery of safe and sustainable services, delivered by a permanent workforce, across its hospitals in Carlisle and Whitehaven.

Following a special meeting of the Trust Board held on Tuesday 21 October, the ‘clinical options appraisal’, which is the result of extensive work since early 2014 with senior clinicians, will now be used to support further widespread clinical engagement with frontline teams, partners, patients and the public at large. A briefing paper has also been published. 

As part of wider plans to improve health and care services right across north Cumbria and in line with the ‘Together for a Healthier Future’ programme, the Trust’s clinical options appraisal is focused on core clinical areas where significant challenges remain which simply must be addressed in order to help the Trust emerge from special measures. These include:

  •  Acute care for high risk medical patients
  •  Obstetrics in particular anaesthetics
  •  Paediatrics
  •  Planned care and outpatients

After detailed work with the Trust’s senior clinicians and in partnership with NHS Cumbria Clinical Commissioning Group (CCG) and the North Cumbria Programme Board*, the Trust has now detailed its early thinking on the potential future solutions to the problems it faces. To be clear, however, the vast majority of patients would continue to receive their care locally with the aim to provide even more care closer to people’s homes. 

To address its particular challenges, the Trust has outlined its clinically preferred way forward (please see accompanying briefing document), based on the current evidence available and subject to further discussion, as follows:

For acute medical care, the transfer of a very small number of emergency high risk medical patients from West Cumberland Hospital to the Cumberland Infirmary in order to improve clinical outcomes.   Over 8,500 lower risk medical patients would continue to be admitted and treated in Whitehaven.

For paediatric care, the creation of a 24 hour short stay paediatric assessment unit at West Cumberland Hospital supported by 24 hour consultant paediatrician access and low acuity beds, with a full inpatient unit at the Cumberland Infirmary working as part of a system-wide child health network Over 80% of children would still receive their care locally in Whitehaven. 

For maternity, although the Trust has discussed potential future solutions, particularly to help address critical safety issues with regard to anaesthetic cover, no preferred option is stated and all potential solutions are fully dependent on the outcome of the independent maternity review being led by NHS Cumbria CCG.

For planned care and outpatients, widespread positive work is already underway to enable more planned care to be delivered at the new West Cumberland Hospital, which will in turn help the Trust meet national waiting standards moving forward. This includes plans to bring back over 4000 outpatient appointments to West Cumbria.

These potential solutions will now be discussed widely with all stakeholders before the Trust makes its final recommendation to NHS Cumbria CCG. It is at this point that the CCG, as local leaders of the NHS, would carry out any formal public consultation, if required.

Dr Jeremy Rushmer, medical director at North Cumbria University Hospitals NHS Trust said: "We have now reached a critical milestone in the Trust’s improvement journey and welcome an open and transparent dialogue with all of our stakeholders about the challenges we face and the potential options available to us.

“As our staff, patients and the public would expect, we simply cannot ignore concerns which have been raised to us by our regulators in relation to clinical standards and expectations and we now must work together to tackle these issues once and for all.

“Change, by its very nature is always difficult and we recognise the challenge this brings particularly for our staff who continue to put their patients first and respond fantastically well embracing the challenges faced on a daily basis. We also recognise concerns raised by the local communities, particularly those in West Cumbria and we are committed to engaging with people fully over the coming weeks and months.

“To be clear, our ambition for North Cumbria is to deliver the safest and highest possible quality of care for the communities we serve and to make our hospitals as good as, if not better, than the best in the NHS. We are already making great strides towards this but there is still a long way to go and further change is vital if we are to succeed.”

Many positive improvements have taken place over the past 18 months, most notably the reduction in Trust’s mortality rate with less people now dying in North Cumbria’s hospitals and more people surviving serious injury or illness and living longer. In addition, staff should be rightly proud of the fantastic achievement of a ‘good’ caring rating for all services and departments from the Care Quality Commission in July 2014 following a visit from the Chief Inspector of Hospitals.

Despite this however, the Trust is acutely aware that the way some services  are currently delivered (acute medicine, maternity and paediatrics) is still not as good as it should be, or to the standards expected of the professional bodies and Royal Colleges of nurses, midwives and doctors. 

Of particular concern is the extreme fragility of the acute medicine service at West Cumberland Hospital which is largely staffed by locums and rated as inadequate under the safety domain by the Chief Inspector of Hospitals, preventing the Trust from coming out of special measures. This situation requires active and exceptional day-to-day oversight to ensure safe care.

Dr Jeremy Rushmer added: “Our most critical issue is acute medicine at West Cumberland Hospital and the fragility of this service should not be underestimated. The potential solution we have outlined to transfer certain patients to Carlisle, will not only will help us provide a sustainable model of care that is robust in the long term, this will also help us attract aspiring candidates, working as part of wider clinical teams, to West Cumbria so that we can stabilise the local workforce.”

Over the coming weeks and months the Trust will engage in detail with all clinical teams across the organisation, as well as with all key partners and has also commissioned independent public engagement regarding the potential solutions outlined.  More details about this will be shared in due course.