2. West, North and East Cumbria

What issues have been raised about this STP?

Health planners are trying to reduce NHS deficits and think about ways to re-organise care. However controlling deficits could prevent facilities being developed that can cope with the health and care social needs of local people.

Proposed changes

The end of consultant-led maternity care at West Cumberland Hospital has been proposed.

Downgrading of West Cumberland Hospital so that only low-risk services are available, with Cumberland Infirmary Carlisle providing high risk services.

Merging all acute stroke services into a single hyper-acute unit at Cumberland Infirmary, Carlisle.

Bed Cuts proposed at West Cumberland Hospital inpatient unit and eight community hospitals. Reducing bed numbers from 133 to 104.

Growing Concerns

The changes in the hospitals in this area are of concern due to issues with the ambulance service in the area; the service was ordered to make safety improvements in January 2017 by the Care Quality Commission. One of the major issues was paramedic vacancy rates.

In a letter to hospital bosses, the head of the North West Ambulance service, Derek Cartwright said he does not believe the controversial plans to transfer women more than 40 miles while in labour are clinically safe. The letter also included reservations about plans to centralise maternity consultants in Carlisle, leaving only a midwife-led unit in Whitehaven.

What are the proposed aims of the STP

  • Eliminate the projected 2020/21 deficit of £168 million;
  • Encourage prevention, self-care and promotion of independence;
  • Invest in services which prevent, reduce or divert demand for hospital to reduce the need to send people a long way from home, and reduce hospital admissions;
  • Stabilise and expand primary care and increase the role of community pharmacies;
  • Optimise care outside hospitals through a programme to implement “Integrated Care Communities” (ICCs) and wrap around specialist community provision.

Like other areas they plan to transfer services out of hospital and into the community. The concern is that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.

Further information

The STP for West, North and East Cumbria is more advanced than many as it has been built on the ongoing Success Regime project, which brings together Cumbria CCG; North Cumbria University Hospitals Trust; Cumbria Partnership Foundation Trust; North West Ambulance Service; specialist providers and GP federations.

The Success Regime plan includes consolidation of the hospital sector and a public consultation has already taken place on some major changes. The consultation ran until 19 December 2016.

As one of the most advanced areas in terms of STP, the area has been awarded capital funding of £30m - £50m to improve access to chemo and radiotherapy by establishing a brand new cancer centre, complete with new equipment at Cumberland Infirmary in Carlisle.

In addition, West Cumberland Hospital will get £30m - £50m extra capital investment to refurbish or rebuild parts of the hospital estate to bring it up to date and between £1m - £5m is going to support the development of eight Integrated Care Communities – local hubs that bring together GPs, social care, community services, mental health services and specialist hospital consultants to support people closer to where they live.

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Hospitals

The consultation outlined a number of options to deliver savings, including abolishing consultant-led maternity care at West Cumberland Hospital (WCH).

The consultation document says that the preferred option is to leave a midwife-led unit at WCH, but it may have to move all services to Cumberland Infirmary Carlisle (CIC).

It is also proposing reforming inpatient paediatric services so that low-risk services are only available at WCH and high-risk services are only available at CIC, and moving all acute stroke services to a single hyper-acute stroke unit at CIC.

The plans also involve a reduction in beds at the WCH inpatient unit and eight community hospitals so that the number is reduced from 133 to 104.

In March 2017 Cumbria CCG's governing body decided on the following proposals:

  • Initially maintain a consultant led maternity unit at both West Cumberland Hospital and Cumberland Infirmary in Carlisle, but if this is not sustainable after 12 months to have a midwife led unit at West Cumberland.
  • Develop an inpatient paediatrics unit for the region at Cumberland Infirmary, while having just a short stay assessment unit and some beds at West Cumberland.
  • Reduce community hospital beds from 133 to 104, phasing out the beds at three units.
  • Maintain 24/7 accident and emergency services at both sites.
  • Develop a hyper-acute stroke unit at Cumberland Infirmary.

These decisions were put before the Council's health scrutiny committee.  Cumbria county council’s health scrutiny committee voted to refer the maternity plans to the health secretary and ask him to overturn this decision. The committee approved the rest of the CCG’s plans. Jeremy Hunt passed the decision over to the Independent Reconfiguration Panel (IPR).

In November 2017 the Independent Reconfiguration Panel (IPR) rejected Cumbria Council's objections to the changes in maternity care.

Criticisms

The plans for hospital consolidation have caused considerable controversy.

Campaign groups in the area note that it is not safe to transfer patients, including mums in labour, stroke patients and the most sick children, long distances on poor roads. The groups are  also concerned about the quality of care elderly people will receive at home if community beds close.

In January 2017 the Care Quality Commission (CQC) ordered the North West Ambulance Service (NWAS) to make safety improvements, highlighting paramedic vacancy rates among its problems. Campaigners noted that the situation with the ambulance service throws into doubt its ability to cope if the changes in hospital use are carried out.

The head of the North West Ambulance service, Derek Cartwright, has written to the Success Regime stating that he does not believe controversial plans to transfer women more than 40 miles while in labour are clinically safe. The letter was leaked to the News & Star local paper.

The letter is also reported to state that he claims transfer times quoted by the Success Regime have been underestimated, that the proposals fail to meet vital guidance on emergency caesareans and even states that paramedics could refuse to transport patients if they felt it unsafe.

But Mr Cartwright's letter reveals that the ambulance service does not support all of the preferred options put forward - and has particular reservations about the plan to centralise maternity consultants in Carlisle, leaving only a midwife-led unit in Whitehaven.

In March 2017, Cumbria Council's Health Scrutiny Committee objected to the planned changes to maternity services. Health scrutiny committee chair Neil Hughes said members were concerned:

  • that the CCG could decide over the future of the maternity unit at West Cumberland without further consultation;
  • about the distance pregnant women would travel between west Cumbria and Carlisle if the unit at West Cumberland is closed; and
  • that proposals for a dedicated ambulance to transport them were not sufficient.