NO action on Lincs Councillors’ request that Health Secretary reviews decision on Grantham A&E permanent overnight closure

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Six months on, the Department of Health has failed to notify the Independent Reconfiguration Panel about Lincolnshire Health Scrutiny Committee’s request to the Secretary of State, to consider its referral of the Hospital Trust’s December 2017 decision, to make permanent the Grantham A&E overnight closure.

This is a clear breach of protocol.

On 10th September, Fighting 4 Life Lincolnshire will draw attention to this at a meeting at the House of Commons. With other NHS campaign groups from around the country, they will discuss with MPs what needs to be done to improve the scrutiny and referral process.

The mysterious disappearing referral to the Health Secretary

Nick Boles MP has not replied to invitations to attend the meeting.

Is he not bothered that no one seems to know what’s happened to the Lincolnshire Health Scrutiny Committee’s referral to the Secretary of State last December, of United Lincolnshire Hospital Trust’s decision to make permanent the temporary overnight closure of Grantham A&E?

The Lincs Health Scrutiny Committee Chair, Councillor Carl Macey, has told Fighting 4 Life Lincolnshire he’s in the dark himself.

At the end of January 2018, Lincolnshire Health Scrutiny Committee asked the Secretary of State to review the Trust’s decision, in December 2017, to make permanent the closure of  Grantham A&E  at night. The Trust made this decision without any consultation with the public or the Scrutiny Committee.

This decision abruptly overturned their  proposal late in 2017 to reopen Grantham A&E overnight, after successfully recruiting enough doctors to meet the Secretary of State’s requirement for safe staffing to restore Grantham A&E to 24/7 opening.

The Dept of Health should have actioned the referral with the utmost urgency. Instead it has sat on the referral for the last 6 months, without even notifying the Independent Reconfiguration Panel of its existence – as the Independent Reconfiguration Panel confirmed on the 5th September.

Despite this being a requirement of the protocol for dealing with referrals:

DHSC:IRP protocol

If members of the public want to know why the Department of Health has not notified the Independen Reconfiguration Panel about the referral, the person to contact at the Department of Health is Neil Townley. His email address is: neil.townley@dh.gsi.gov.uk. Please copy your email to Cllr Macey: cllrc.macey@lincolnshire.gov.uk and Nick Boles MP: nick.boles.mp@parliament.uk

The full list of Health Scrutiny Committee members and their contact details is here.

Campaigners are writing to Neil Townley and their email will be downloadable shortly, please come back soon to find it.

Has the Department of Health even accepted the referral?

Fighting 4 Life Lincolnshire campaigners point out they have not seen any documentary evidence that the Department of Health has accepted the referral.

Cllr Carl Macey has told Fighting 4 Life Lincolnshire that on Monday 10th September he will send them the Department of Health’s acceptance of the referral.

Prompted by campaigners, on September 2nd, Cllr Carl Macey said on facebook that he believed that the Health Scrutiny Committee “haven’t heard anything what so ever” since “the Department of Health finally accepted the referral at the end of February.”

He added

“However we will chase it once again to see when we are likely to finally receive the outcome…it’s ridiculous, never ceases to amaze me they can decide to close a service due to safety over night, but it takes months/years for them to do something to put it right…now they will be reconvening after summer recess we will once again chase it.”

Update 24.1.19

After the 23.1.19 Health Scrutiny Meeting, Cllr Carl Macey posted on the Fighting 4 Life Lincolnshire the letter the Department of Health had sent on 6th November.

This responded to Cllr Macey’s “chasing” letters of 6th and 14th September. Cllr Macey’s 14th September letter to the Minister of Health Steven Barclay, included the following requests:

“In particular, you have asked the CCG and the Trust to prepare a report by December 2018, including a timetable, on how they have carried out, or plan to carry out the engagement and the consultation envisaged. I look forward to receiving this information on engagement and consultation at the earliest opportunity.
The IRP report to which you have referred relates to a previous report by the Health Scrutiny Committee for Lincolnshire in December 2016, on which the Secretary of State issued a decision on 2 August 2017. I would request from you clarification of the status of the Committee’s report submitted on 31 January 2018. In particular, I would like an indication whether your recent letter represents a determination of the January 2018 report, or whether this report remains under consideration.

Hospitals Trust Board meeting on September 7th heard that Grantham A&E should not look to reopen 24/7

A damaging consequence of the failure to action the referral, is that on 7 September the Chief Operating Officer, Mark Brassington, told the United Lincolnshire Hospitals Trust Board meeting, that Grantham A&E should not look to reopen 24/7. He quoted the Clinical Senate’s view that it was unsafe to do so.

Lincolnshire Health Scrutiny Chair Carl Macey confirmed on facebook that:

“There would be no plan to reopen it overnight, as it will form part of the acute service review & STP which wouldn’t come out until next year when they would have finalised there [sic] plans for Grantham & consultation will begin”

Has Cllr Carl Macey forgotten that last February he wrote to the Department of Health asking the Health Secretary to advise on separating the Grantham A&E permanent closure consultation from the Sustainability and Transformation Plan consultation?

On 28.2.18, Cllr Macey sent the Department of Health additional information in support Lincolnshire Health Scrutiny Committee’s referral. This included the  suggestion that it would be possible to deal with the lack of consultation on Grantham A&E’s permanent closure without having to wait for the Sustainability and Transformation Plan consultation, by:

“separating the consultation on emergency and urgent care provision (including Grantham A&E) in Lincolnshire from the consultation on the rest of the Lincolnshire STP. However, the Committee understands that such a decision is outside the remit of the Lincolnshire CCGs, and rests with NHS England. I would like to know if the Secretary of State as part of his determination of this referral could indicate if he has a view on accelerating the emergency and urgent care elements of the STP consultation.”

Negligence in letting the referral go awol

Given the urgency of the referral, Lincs Health Scrutiny Committee seems to have been negligent in letting it go awol. They might as well not have bothered making the referral, if they weren’t going to make sure the Dept of Health dealt with it appropriately.

But the Scrutiny Officer waited until July, just before the Parliamentary recess, before chasing the Department of Health for an update, which the Department of Health did not reply to.

Prompted by campaigners, the Lincolnshire Scrutiny Officer reportedly contacted the Department of Health again last week, but to date has not received a reply.

Cllr Carl Macey defended Lincs Health Scrutiny Committee on facebook, saying

“In this instance I don’t see the fault being at HSC doorstep, we took the strongest action we could take, actioned our legal rep on three occasions to sign off and agree our response and Simon as the HSC officer followed the guidance in place as he did on the previous referral and again with our legal rep supporting the submission guidance, I do agree that the department of Health used it as a football initially, but if your [sic] calling into question the legalities of it I would suggest you speak to the legal rep David Coleman at LCC to corroborate this.”

Flaws in the Scrutiny Committee’s referral documentation

Following the referral on 31 Jan 2018, there was a month-long exchange of correspondence, where the Department of Health pointed out flaws in the referral documentation and the Health Scrutiny Committee twice supplied additional information, on 21.2.18 and on 28.2.18.

Challenge to referral regulations which pre-date Sustainability and Transformation Plans and centralised control of local NHS organisations

In the 28.2.18 submission, the Health Scrutiny Committee made an important challenge to the Department of Health.

It contested the applicability of the 2013 regulations on referrals, on the grounds that they predate STPs and the centralised control of local NHS organisations. This made it impossible, in the Health Scrutiny Committee’s view, to apply these regulations now.

The final submission of the referral to the Secretary Of State was made in mid March, when Lincolnshire County Council’s legal officer signed off the referral and this was sent to the Department of Health.

Pressure from NHS Improvement

The hospitals Trust decision to make permanent the temporary closure was made under pressure from NHS Improvement last December – after United Lincolnshire Hospitals Trust had announced they planned to restore Grantham A&E to 24/7 operation, after successfully recruiting the number of staff the Independent Recofiguration Panel and Secretary of State had confirmed as necessary to safely return it to 24/7 operation, when they made the temporary closure in August 2016.

NHS Improvement commissioned the East of England Clinical Senate to review the plan to reopen Grantham A&E 24/7 and the Clinical Senate obligingly concluded it would be unsafe, even though ULHT had recruited the number of doctors the Secretary of State had specified in his advice about the conditions for ending the temporary overnight closure of the A&E.

Correspondence between Lincs Health Scrutiny Committee and Department of Health

Documents that campaigners have seen relating to the 31.1.18 referral show that on 12.2.18 the Department of Health told Cllr Macey that:

  • The referral didn’t meet the requirements of the relevant regulations.
  • Nor did it show any evidence that sufficient staff had been recruited by the hospitals trust to safely operate Grantham A&E 24/7.
  • Nor did it explain the steps the Health Scrutiny Committee had taken to reach an agreement with the Clinical Commissioning Group to fulfill the Secretary of State’s previous request, regarding sustainable safe staffing levels required to restore 24/7 A&E at Grantham.

On 21.2.18, Cllr Macey then sent a report containing what he and the Scrutiny Officer thought was the additional information requested by the Department of Health.

On 27.2.18 the Department of Health replied to Cllr Macey saying he hadn’t shown what communication, if any, he’d had with the Trust or Clinical Commissioning Group. The  Department of Health asked for a report on this and copies of correspondence with the Trust or Clinical Commissioning Group, where they put their side of the story.

The following day, Cllr Macey replied to the Department of Health with a report contesting the  Department of Health’s statement on 12.2 18, that the referral doesn’t meet the requirements of relevant regulations. He also provided further information about the grounds for referral.

Cllr  Macey’s 28.2.18 reply to Department of Health made the interesting point that:

“Furthermore, both the regulations and guidance were drafted prior to the introduction of top-down STP process, which appears to be centrally-driven; and overseen and managed by NHS England. This makes is difficult for health overview and scrutiny committees to enter a meaningful dialogue with local CCGs and provider trusts, if their hands are tied by other parts of the NHS.”

He then mades some suggestions about how to deal with the Grantham A&E consultation in this context, including:

“separating the consultation on emergency and urgent care provision (including Grantham A&E) in Lincolnshire from the consultation on the rest of the Lincolnshire STP. However, the Committee understands that such a decision is outside the remit of the Lincolnshire CCGs, and rests with NHS England. I would like to know if the Secretary of State as part of his determination of this referral could indicate if he has a view on accelerating the emergency and urgent care elements of the STP consultation.”

Cllr Macey concluded that all the requirements for a valid referral to the Secretary of State had been fulfilled.

But who knows whether the Department of Health agreed?

Here’s where you can download (pdf) the Jan-Feb 2018 correspondence between Cllr Carl Macey and the Department of Health’s Neil Townley.

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