AGENDA ITEM NO. 6(j)
REPORT TO: Social Care and Health Policy & Performance Board
REPORTING OFFICER: Executive Director Social Care, Housing and Health
SUBJECT: Scrutiny of Proposed Changes in Clinical Services
North Cheshire Hospitals NHS Trust
1.0 PURPOSE OF REPORT
1.1 To provide members with details of changes to Clinical Services being proposed
by North Cheshire Hospitals NHS Trust (appendix 1)
1.2 To provide details of how the proposals have been scrutinised so far (Appendix 2)
1.3 To recommend actions required for the next stages of the scrutiny process, prior to
the trusts implementation of any changes (Appendix 2, paragraph 6)
2.0 RECOMMENDED: That
(1) this initial report be noted, comments made and incorporated into a
final report to PPB once further requirements have been satisfied; and
(2) the recommendations and actions set down in Paragraph 6 of Appendix
2 be noted as appropriate action to be taken forward by the North
Cheshire & Halton PCT Trust Boards and progress reported to a
3.0 BACKGROUND INFORMATION
3.1 On 6th
November 2003, the Board of North Cheshire Hospitals NHS Trust
approved proposals to reconfigure Clinical Services. These proposed changes
affect both Halton and Warrington Hospitals. Details are provided in the paper
“Clinical Services Review – A Roadmap for our Hospitals Future” presented to the
Trust Board – Appendix 1.
3.2 The reconfiguration proposed constitutes a substantial change to services.
Accordingly, on 11th
November, the Social Care and Health PPB agreed a process
for scrutiny of the matter.
3.3 The proposals build on work previously undertaken during 2002 and reported in
the Trusts document “A Vision for Future Changes”.
3.4 The Chairman, Chief Executives of the North Cheshire Hospitals and Halton PCT
Trust have been invited to attend the meeting of Policy & Performance Board on
20.01.04. This will allow members of PPB to seek further clarification of points
and to hear from the senior team, their response to the issues raised by the initial
4.0 SCRUTINY PROCESS AND ISSUES
4.1 A scrutiny panel, established under the Chairmanship of Cllr T McInerney has
examined the proposals for change. Full details of the process, findings and
recommendations are set down in Appendix 2.
4.2 Whilst recognising that the proposed changes affect both Halton and Warrington
Hospitals, the greatest impact is upon the residents of Halton.
4.3 The proposal that all emergency surgery be transferred to Warrington warranted
4.4 Whilst not a part of the proposed changes, the provision of the two intensive care
beds at Halton, has a central bearing on hospital services, both now and in the
future. This issue has therefore been fully examined.
4.5 It will be essential that the Board of the NHS Trust set down their clear vision for
the development of Halton Hospital Campus. This as a key part of continuing
acute and medical services.
5.0 POLICY IMPLICATION
5.1 The direct impact of these proposals is upon Hospital Services. However, they
have considerable consequences for the health and wellbeing of all people living in
the Borough. Health remains the top priority of the Borough Council. Therefore it
is essential that local services address the specific needs of the population and that
access to Hospital Services is not compromised.
5.2 The proposed changes are likely to have specific impact upon Social Care
Services. It is therefore essential that as details are developed, they address
requirements across the “whole system”.
5.3 People in Halton rely heavily on public transport, therefore the transport
implications of the proposed changes require further exploration.
6.0 BACKGROUND PAPERS
6.1 “A Vision for future Services” – North Cheshire Hospitals NHS Trust 2002 –
Available Grosvenor House, John Webb.
Clinical Services Review
A Road Map for our Hospitals’ Future
The purpose of this document is to set out a clear direction for the development
of clinical services at Halton and Warrington Hospitals. More specifically it aims
to achieve three things:
1. Make clear our view of which services should be provided from the
Warrington and Halton Hospital sites;
2. Inform people of what has happened to the suggestions made in the
Trust’s 2002 document ‘A Vision for Future Services’;
3. Outline some changes that we wish to make to the delivery of surgical
services in order to further improve patient care.
The ‘Vision for Future Services’ Document
A discussion document; 'A Vision for Future Services', was drawn up in late 2002
in response to the NHS Plan. The document outlined both the Trust’s vision for
care and a large number of proposals for change in the way in which some
health services might in future be delivered at Warrington and Halton Hospitals.
The document was widely circulated to hospital, health and social care staff as
well as patient and public representatives throughout North Cheshire in order to
canvass their views. It was also formally presented to local authority Overview
and Scrutiny Committees (OSCs) in Warrington and Halton.
The ‘Vision for Future Services’ made clear the Trust Board’s expectations in a
number of key areas. These were that:
“By 2008 the hospital services serving the residents of North Cheshire will be
amongst the best in the UK.
Halton and Warrington Hospitals will be fully integrated yet will play their unique
role in delivering health benefits to local people.
…, both hospitals will provide the range of specialties that they do today. This
means that local residents will be referred to their local hospital for a consultant
opinion on their illness or condition…”
These statements remain valid today and have strongly influenced the Trust’s
Progress Since 2002
In the fast-changing environment that is the modern NHS, much has inevitably
happened since the ‘Vision for Future Services’ document was issued. Major
changes include the launching of the national policy on choice under which
patients will increasingly select the hospital of their choice, an increased national
commitment to keep services local wherever clinically feasible and an increased
national focus on ensuring that hospitals’ ability to treat patients is maximised
through best use of their clinical capacity.
These changes, together with the views of a large number of clinicians and local
stakeholders, have led us to modify and further develop the proposals and
suggestions contained within the ‘Vision for Future Services’ paper – in some
cases quite radically.
Since the ‘Vision for Future Services’ was issued, there has been very extensive
discussion about its contents. It is both my view and that of our front-line staff
that the time is now right to bring the discussion phase of our work to an end and
move to decision-making and then implementation.
Current and Proposed Service Profile in North Cheshire Hospitals NHS
The box below illustrates the location of services across the Trust’s two hospitals:
Service Warrington Site Halton Site
Child Health Y N
Critical Care Y Y
Emergency Care Y Y
Maternity Y N *
Medicine and Elderly Care Y Y
Outpatients Y Y
Pathology Y Y
Pharmacy Y Y
Radiology Y Y
General Surgery Y Y
Therapies Y Y
Trauma & Orthopaedics Y Y
Women’s Health Y N
(* Some Maternity outpatient services at Halton)
The Trust is not proposing a major reorganisation of services. We are intending
to keep the current disposition of specialties at both hospitals in order to remain
able to deliver care as close to our patients as possible.
We are also not proposing widespread change at the sub-specialty level. With
the exception of surgical services (which are discussed below and where we
believe that by making some changes we can treat patients better), we are not
proposing significant changes to the location of services.
Appended to this paper are two documents:
A position statement that describes where we are in relation to the specific
proposals for service development that were included within the ‘Vision for
Future Services’ document. Many of these developments have already been
implemented to the benefit of patients (eg improvements to the Minor Injuries
Unit at Halton General hospital) while others remain aspirations of the Trust but
are dependent upon either the decisions of external NHS bodies or on external
funding (eg the proposed development of additional renal dialysis stations).
A service profile by Directorate. This describes the services provided at both of
our hospitals in greater detail than the above table. In so doing it makes clear
our commitment to preserving the current broad disposition of services (with the
exception of the proposed changes to surgical services).
Reconfiguring Surgical Services
As mentioned above, the one area where we believe that significant benefits for
patient care would be generated from changing elements of the current service
model is within surgical services.
These proposals, which have been generated by the Trust’s surgeons at both
Warrington and Halton Hospitals, would see a significant increase in elective
surgery on the Halton General Hospital site coupled with a centralisation of
surgical emergencies onto the Warrington Hospital site.
In order to treat patients ever more quickly, it is essential that hospitals make the
fullest use of their bed, theatre and staff capacity. To date, the Trust has not fully
utilised the capacity of Halton General Hospital. It is therefore proposed that a
wider range and number of elective surgical procedures will in future be
undertaken at Halton. This would include a range of upper gastro-intestinal,
colorectal, vascular, breast and urology procedures. It is anticipated that 75
additional patients will be treated each week at Halton General Hospital once
these changes come into full effect.
This additional work at Halton General Hospital will allow the Trust to not only
treat patients more quickly but will also enable us to offer more Runcorn and
Widnes patients the ability to have their surgery at their local hospital as opposed
to having to travel to Warrington as they do now.
It will in no way compromise the right of Warrington patients to be treated in their
local hospital (as the same surgery will remain available at Warrington). It will
however allow the Trust to offer some Warrington patients the choice of being
treated at Halton should they so wish. Patients will not be compelled to move
between sites to receive their elective surgery under this initiative.
Surgical emergencies are currently managed on both the Warrington and Halton
Hospital sites. However the vast bulk of such cases are already managed at
Warrington with Halton General Hospital only ever having dealt with a very small
number of surgical emergency patients. The Trust’s surgeons believe strongly
that the four or five surgical emergencies per day that are currently seen at
Halton could be better managed by a single dedicated emergency surgical team
operating at Warrington Hospital.
The benefits of the proposed surgical changes for patients would include:
fewer planned operations cancelled because of pressure from emergency
surgery and a lack of availability of beds
reduction in waiting times for surgery
increased opportunities for patients to book their operations in advance
a wider range of consultant sessions on the Halton General site
an opportunity for more patients to receive their operations at their most
local NHS hospital
shorter stays in hospital
all emergency surgical patients would be seen by a consultant daily.
The benefits for staff and our Trust would include:
security and reassurance for staff at both hospitals about the future
direction of services
the ability to achieve targets for day case surgery and access times for
inpatients and outpatients
increased volume of people being treated at Halton Hospital
surgeons currently based at Warrington would have sessions (theatre,
endoscopy, out-patients) on both sites.
considerable reduction in waiting list costs and pressures
the ability to make the best use of Halton General Hospital and in
particular, the High Dependency Unit (HDU) and provide a critical care
facility for the whole of North Cheshire
all surgical emergencies managed on one site with full team cover
reduced costs for locum cover for surgeons
the ability to draw up an integrated rota for junior doctors to comply
with the European Working Time Directive (EWTD) and New Deal
enhanced opportunities for emergency surgical training and more
attractive job plans for new consultants, leading to improvements in
recruitment and retention.
These proposed changes to emergency surgical services will not affect the Minor
Injuries Unit at Halton General Hospital. This will continue to care for the same
mix of patients as now.
Intensive Care at Halton General Hospital
Neither the Trust’s statement of its clinical direction nor the proposed changes to
surgical services are dependent upon the status of the two Intensive Care beds
at Halton General Hospital. Nonetheless the future status of these beds is very
understandably a matter of considerable concern to both staff and the public.
Critical care at Halton General Hospital is delivered through high dependency
beds, which everyone agrees must be maintained, and two intensive care beds.
High dependency beds provide the correct level of clinical support for the critical
care requirements associated with the vast majority of elective surgery
conducted at Halton. Intensive care beds provide the highest level of care for
patients suffering multi-system failure.
The latter beds are temporarily closed owing to a difference in professional
opinion regarding the level of anaesthetist cover required to safely maintain
them. The Trust has made clear its intent to reopen the ITU beds at Halton
General Hospital but requires clear direction on the clinical safety issues prior to
being able to move ahead with this.
The Trust has therefore expressly invited the Commission for Health
Improvement (CHI- the national NHS inspectorate) to provide a definitive ruling
on whether or not the beds at Halton can be run safely using a proposed model
of joint cover between Consultant Anaesthetists and Intensivists.
Communicating and implementing our proposals
I am committed to full, open and proactive communication about our proposals
for change. Following the discussion at the Trust Board, we will continue to
discuss our proposals with key stakeholders including the Oversight and Scrutiny
functions of our two Local Authorities.
Following this, we will be looking to implement the surgical services changes at
the earliest opportunity.
Change within the modern NHS will continue apace and will demand that we
keep our services under continual review. It is therefore neither sensible nor
possible to rule out changes to our services for all time.
Notwithstanding this reality, I want to be clear to staff, patients and local people
about the clinical direction of this Trust. This paper makes clear the Trust Board’s
commitment to continue to deliver services at both Warrington and Halton
Hospitals in order that local people can wherever possible be treated at their
local hospital. In the few areas in which we are proposing immediate changes
we believe that this can be strongly justified in terms of the clinical benefits that it
will deliver to local people.
Clinical Services Review Position Summary
Increasing Hospital Capacity
(1.) Ensure Sufficient Outpatient, day case, inpatient and
diagnostic capacity to deliver NHS Plan targets
• North Cheshire Hospitals is a national pilot site for the
Improvement Partnership for Hospitals (IPH) programme which
is aimed at achieving better care without unnecessary delays
along whole patient pathways focussing on the below criteria
and on promoting organisational and leadership development at
o Elective Pathways
o Emergency Pathways
o Transfer / Rehabilitation and Discharge
This major service development initiative will ensure that the Trust
uses its clinical capacity optimally. By achieving this, we aim to
become amongst the very best run hospitals in the NHS.
(1.1) Increase number of patients receiving their care as a day
• North Cheshire Hospitals is currently being supported by the
Modernisation Agency in a development programme for increasing
the number of elective procedures performed as a day case. We
are aiming to deliver national best practise levels of day case
surgery as a result of this work.
• There is a dedicated day case unit for surgery at Halton Hospital
and dedicated day case beds at Warrington Hospital for women’s
services, orthopaedics and ophthalmology.
• Plans have been agreed for the development of an extension to the
scope room at Halton Hospital that will consist of 3 beds and 8
specialist chairs. The expected start date is January 2004 with a
completion date in April/May 2004. This will enable the transfer of
endoscopy work currently undertaken in theatres in Halton Hospital
releasing capacity for an increase in day surgery.
(1.2) Develop sufficient bed numbers to deal with growing
demand in Medicine and Elderly Care
• Previous analysis of our capacity needs identified the need for
additional beds across the health economy including community
nursing and intermediate care provision. This now needs revisiting
with a more rigorous analysis of throughput as part of the
Improvement Programme for Hospitals. This more detailed work
will also examine alternative models to hospital admission and will
lead to a clear understanding of our capacity needs.
• Developments in transitional care include intermediate care beds in
Chestnut House in Appleton and the Warrington Primary Care Trust
is aiming to develop further intermediate care beds in conjunction
with a private provider. In Halton, the Evercare model is being
piloted which is preventing unnecessary admission to acute care
and there has been an increase of 6 intermediate care beds in
Widnes, 6 in Runcorn and a further 5 nursing beds in Widnes.
(1.3) Expand consultant and other clinical services to meet
current demands for care
• Since 2001 14 new consultants have been appointed to the Trust in
Anaesthetics, Histopathology, A&E, Radiology, Urology, Trauma
and Orthopaedics and Cardiology.
• A further Breast Surgeon to be appointed next year
• The Trust is committed to the development of vascular surgery
across the local health economy and is very actively seeking
funding for a further consultant appointment. This will secure the
future provision of emergency vascular services to provide local and
accessible care and treatment for populations in North Cheshire
and St Helens and Knowsley.
• The consultant surgeons rota will be expanded to a full complement
pending the permanent appointment of two associate specialists
• Extensive work in recruitment and retention strategies across all
Clinical professional groups being undertaken, along with workforce
redesign and creation of new roles to meet future demands..
(1.4) Put in place arrangements to protect inpatient capacity
from the impact of emergency admissions
• All complex Adult ENT and all Children’s surgery is carried out at
• The proposal to reconfigure Surgical Services across the two
Hospital sites by increasing the variety and volume of elective
surgery carried out at Halton and consolidating emergency surgery
at Warrington Hospital offers the most significant development in
surgery in North Cheshire. It will allow capacity for elective surgical
care to be protected from the demands of emergency cases. This
will allow waiting times to be shortened and the number of patients
whose operation has to be cancelled to be reduced.
(1.5) Genito-Urinary Medical (GUM) Services • The Commission for Health Improvement has recommended that
changes should be made to the accommodation GUM services at
Warrington Hospital are delivered in order to enhance patient
confidentiality. This is the subject of an accommodation review and
the Trust is committed to addressing this issue as a matter of
• There has been expansion of community based services to address
increased demand resulting from an outbreak of bacteria resistant
Reforming Emergency Care
(2.) Provide high quality timely diagnosis, treatment and where
necessary, admission to hospital for unscheduled patients
/ Provide range of alternative points of access for patients
and referring GPs / Address recommendations of CHI
Review 2002 for adequate facilities in A&E Department
Reforming Emergency Care
• A multi-million pound development of the A&E Department at
Warrington is now underway. Once completed, this will radically
improve patient care. The scheme is scheduled for completion in
• Following a recommendation from the Commission for Health
Improvement, protocols are in place with local G.P.s and the
ambulance service in Halton to ensure managed medical
emergencies can be admitted safely.
• Ward A1 at Halton has been developed with medical and surgical
admissions facilities for same day/ next day rapid access to clinics
for urgent G.P. referral for consultant opinion. The facility is also
providing rapid treatment and diagnosis, so preventing inpatient
episodes, example patients requiring Deep Vein Thrombosis
treatment or blood transfusion
• A major refurbishment of the Minor Injuries Unit at Halton General
Hospital is now under way and completion is scheduled for August
• Physician of the day/week remains the optimum model for providing
effective care and facilitating appropriate discharge of patients and
is required at Halton and Warrington Hospitals. Work is ongoing
within the Medical Directorate to progress this within the constraints
of the European Working Time Directive (EWTD) and the existing
establishment of consultants.
• Protocols in place with Mersey Regional Ambulance Service for
direct referral arrangements to Coronary Care Unit at Halton for
myocardial infarction (heart attack) patients
(3.). Develop Specialist Services
Develop number of beds for renal dialysis to match
• Local Primary Care Trusts are currently conducting a major review
of renal services. This will lead to a 5 year strategy for the
development of renal services including haemodialysis across
Cheshire and Merseyside. This will direct the number and location
of additional renal dialysis stations within our hospitals. As a Trust
we are committed to developing further renal dialysis stations and
we will feed the views of our clinicians into this regional review. The
findings and recommendations of the review are expected in Spring
Augment diabetes, respiratory illness and stroke services • 6 acute assessment stroke beds with manual monitoring equipment
have been placed in Ward A1 at Halton bringing the total stroke bed
complement to 6 assessment and 21 rehabilitation beds at Halton
• 6 acute assessment stroke beds with automatic monitoring
equipment have been developed on B14 at Warrington providing a
total stroke bed complement of 24 assessment and 24 rehabilitation
• The Trust recognises the need for the development of integrated
diabetic services in both Warrington at Halton. We will work with
our Primary Care Trusts to bring forward proposals on how the
service should work and how it can be funded.
• The respiratory service has been redesigned to provide increased
support for respiratory and lung cancer services with additional
specialist consultant sessions. Work is underway to develop non-
invasive ventilation within the respiratory ward at Warrington and a
nurse led admission service at Halton for 6 beds.
Expand and Develop he Clinical and non-clinical
workforce to meet demands for services.
• North Cheshire Hospitals Trust is currently developing a Workforce
1. Meet the demands placed upon services over
2. Accommodate changes in availability of clinical and non-
clinical staff with the introduction of the European
Working Time Directive (EWTD)
A costed action plan is to be agreed and submitted to the Cheshire and
Merseyside Strategic Health Authority in December 2003.
North Cheshire Hospitals NHS Trust Service Profile
CHILD HEALTH • Children’s services are located on the Warrington site providing
inpatient and outpatient care to babies and children from the North
NEONATAL SERVICE • Babies are accepted into a purpose built neonatal unit from 26
weeks of age/ 700gm birth weight. The unit has 20 cots and
provision for 3 intensive care cots. A team of community neonatal
nurses provides an outreach service for discharged oxygen
CHILDRENS SERVICE • Children are cared for in an integrated medical and surgical
paediatric unit. In addition to the general paediatric beds there are
cubicles for children with infectious disease or serious illness plus
one that is equipped and staffed for high dependency treatment and
• Outpatient services are held in a purpose built department, which is
separate from adult services. Visiting consultants provide outpatient
Cardiology, urology, rheumatology, ophthalmology,
dermatology, cystic fibrosis, specialist paediatric surgery,
general surgery and visual stimulation.
• Specialist nursing teams provide outreach nursing services in the
community to children with diabetes, epilepsy, and respiratory care
and continuing care.
CRITICAL CARE SERVICE DIRECTORY • Critical Care is the directorate that provides the following services
Anaesthetics – provided on both hospital sites
Intensive care and high dependency care- provided on both
Coronary Care Nursing – provided at Halton
Theatre Services – provided at both hospital sites
Sterile Services – provided at both hospital sites
Acute Pain Management – provided at both hospital sites
Chronic Pain Management – provided at both hospital sites
Endoscopy – provided at both hospital sites
ACCIDENT AND EMERGENCY CARE/MINOR INJURIES • Emergency care is provided to Warrington, Halton and surrounding
areas with a full 24 hour service at the Warrington site. The Halton
site provides Minor Injury care between the hours of 09.00 and
23.00 each day of the week of a medical or surgical nature.
• Streaming of patients, has taken place at both sites with the three
streams at the Warrington site being Minors, Majors and
Paediatrics. The two streams at the Halton site are adult minor
injuries and paediatric minor injuries.
• Nurse Practitioners work across both sites and the services of a
Nurse clinician are now available at the Warrington site and this will
be extended to the Halton site in the near future.
• There is a short stay unit that is presently incorporated within Acute
Admissions Unit due to the refurbishment of the department. By
summer 2004 there will be an 11 bedded Short Stay Unit within the
Accident and Emergency Department where patients will be cared
for on a short-term basis avoiding admission to an in-patient bed.
Maternity • Maternity services for the population of Warrington, the majority of
Halton and women who chose to deliver at Warrington but live in
other areas, are based on the Warrington site.
• The maternity services are provided in a dedicated unit that was
opened in 1994 offering modern and well equipped facilities where
the multi-disciplinary team is focused on effective team working to
provide excellent women-centred care.
• Hospital midwives provide midwife antenatal bookings. Community
midwives provide home registration to the majority of pregnant
women in Warrington.
• All obstetricians provide routine antenatal care. All women have a
named community midwife and we offer midwifery led care to low
risk pregnancies. High risk pregnancies also benefit from a
community midwife and hospital support.
• Parentcraft education is offered on site and in the community. We
provide a drug/alcohol liaison midwife and support for teenage
pregnancies with midwife input.
• We offer a midwifery led smoking cessation service. We have
recently appointed a Surestart midwife for the West area of
• In July 2003 the Antenatal Day Unit opened, with dedicated on site
scanning facilities. The aim of this unit is to allow pregnant women
to remain at home with their partner and families, where possible
this unit will allow us to monitor high risk patients effectively and
allows midwives, obstetricians and ultrasonographers to work as a
team. It will also reduce admissions to the delivery suite of women
who are not in labour.
Warrington • Gynaecology inpatient services are provided in a dedicated ward
treating both emergency and elective patients whilst women
undergoing day case surgery are treated in a specialist women’s
day case centre.
• Outpatient facilities are provided in the separate women’s specific
• There is a Senior Nurse Practitioner working and managing the
Women’s Day Care Centre who leads on supervision of all nurse
led clinics within the centre.
Halton • The service within the Halton site is provided as a visiting service
from Countess of Chester Hospital and St Helens & Knowsley NHS
• At Halton, outpatient and day case care is provided with those
patients requiring inpatient stay being treated at the respective
consultants home hospital i.e. Countess of Chester and Whiston.
MEDICINE AND ELDERLY CARE • Medicine and elderly care is provided at both Warrington and
Halton. Warrington provides specialist Respiratory, Diabetology,
Cardiology, Gastroenterology and Elderly Care treatment as well as
general medicine. All of these specialities are supported by
• Halton has 6 wards providing the same range of in patient
specialities and has access to 2 Coronary Care Unit beds in the
Critical Care Unit.
• Genito-Urinary Medicine and Dermatology are provided as
outpatient services on both sites, and Dermatology has links with
the Royal Liverpool for inpatient care. There is a day care treatment
centre on the Warrington site.
• Specialist Nurses are employed in Respiratory, Rheumatology,
Gastroenterology, Cardiology and Diabetology and form an integral
part of these services.
• A Stroke Care Co-ordinator and Tissue Viability Nurse are also
employed to support the medical directorate. Rheumatology is
incorporated into Medicine on the Halton site, but is part of the
Orthopaedic Directorate at Warrington
• Cardiology and Respiratory are supported by the Echocardiogram
Services Department which is again provided on both sites.
OUTPATIENTS • Outpatient Departments are located at both Halton and Warrington
hospitals. The total number of outpatients seen during April 2000 to
March 2001 at Warrington 185,418, at Halton 66,419.
• Clinics are held on both sites and usually during Monday – Friday
8.30 am to 5.00 pm.
• Satellite clinics are also held on both sites from Clatterbridge
Hospital Oncology, Walton Hospital Neurology.
• Satellite clinics are also held at Warrington from the Whiston
Hospital Department of Plastic Surgery.
• In addition to the specialty clinics, both hospital sites provide;
Ear dressings service
Nurse led clinics
• Site specific outpatient facilities are;
Cancer Information resource centre
Dermatology Day centre – Treatment area for certain
PATHOLOGY • Pathology is a multidisciplinary diagnostic Directorate providing
Haematology, Biochemistry, Microbiology and Histopathology to
both hospital sites.
• Approximately fifty per cent of work is generated in Primary Care
and work is continuing to improve the availability of service to
• The major pathology site is on the Warrington site with satellite
facilities at Halton Hospital.
• Scientific staff attend and help run the H pylori clinic, GTT clinic,
anticoagulant clinic and Breast Clinics together with outreach
anticoagulant clinics at Castlefields Medical Centre.
PHARMACY • The department provides pharmaceutical services at Warrington
and Halton General Hospitals and a satellite pharmacy in the
mental illness unit at Hollins Park, which is part of The 5 Boroughs
Partnership. The Warrington pharmacy moved to a new building in
April 2000. It also has service level agreements with the Halton,
Warrington, Cheshire West, Ellesmere Port & Neston PCTs for
support to their community- based services and for support to
Halton Haven hospice in Halton and St Rocco’s Hospice in
Warrington. Services are also provided to the Brooker Centre and
associated units of the 5 Boroughs Partnership in Halton under a
service level agreement
RADIOLOGY • Radiology is located on both hospital sites with an additional
satellite A&E X-ray department at Warrington and the local Breast
Screening service, which covers Warrington, Halton, Whiston and
• Both hospital sites have CT units, Ultrasound departments and the
Specialist imaging suites. Warrington also has the Nuclear Medicine
department. These provide a diagnostic and therapeutic imaging
service, x-ray film storage and retrieval and radiological advice to
the clinicians of the Trust and the PCT’s.
• Magnetic Resonance Imaging is available on the Warrington
• The A&E X-ray department at Warrington is open 24 hours per day,
365 days per year for non-routine, urgent examinations. Both Halton
and Warrington x-ray departments are staffed until 9pm each day
but only deal with non-routine work after 5pm and at weekends. The
core hours of the departments are 9am to 5 pm, Monday to Friday.
There is limited GP patient access outside the core hours. The
remainder of the service is supported by an on call arrangement
staffed by radiologists and radiographers.
SURGICAL SERVICES • The Surgical Directorate comprises General Surgery and its related
sub-specialties; Urology, Ophthalmology, ENT, Orthodontics and
• Both hospital sites currently provide emergency, elective and
outpatient treatment for surgical and urological patients. Treatment
of ophthalmic and ENT emergencies are only provided at the
Warrington site but elective and outpatient treatment for these
specialties and orthodontics and oral surgery are provided on both
• Proposals for significant reconfiguration to surgical services in
North Cheshire are referred to in the main body of this document
THERAPIES The following services are provided across the two sites:
• Rehabilitation (stroke, neurological, elderly, surgery, amputees and
input into Rapid Response services)
• Cardiac Rehabilitation
• Respiratory (including input into Rapid Response Respiratory)
• Speech Therapy for Dysphagia and voice problems
• Nutrition and Dietetics for Diabetes, Health Promotion, Nutrition
Support and general dietetic advice
• Women's health
• Community physiotherapy/Occupational Therapy and Speech and
• Services are provided on an in-patient and out-patient basis. Our
patient services are delivered in a variety of settings, which include
Hospital outpatients, Community Clinics, GP Practices and peoples
own homes. As part of Intermediate Care we also deliver a service
to Padgate House and Hawthornes.
TRAUMA AND ORTHOPAEDICS • Trauma and Orthopaedic adult and paediatric services are provided
in the main at Warrington with day case only at Halton.
• Emergency care is provided in two orthopaedic wards incorporating
a trauma admissions unit and orthopaedic rehabilitation beds.
Elective care is provided in a dedicated elective orthopaedic unit,
which also includes pre-operative assessment and physiotherapy
NORTH CHESHIRE HOSPITALS NHS TRUST
RECONFIGURATION OF CLINICAL SERVICES
HALTON BOROUGH COUNCIL SCRUTINY PROCESS
1.1 On 6th
November 2003, Ian Dalton, Chief Executive Officer of the Hospital Trust
presented his paper, “Clinical Services Review – A Road Map for our Hospitals’
1.2 The Board of the Trust accepted this report, with a recommendation that the Trust
work with key partners to develop action plans.
1.3 The proposals build on work undertaken by the Trust in 2002 and previously
reported to Social Care and Health Policy and Performance Board. This work was
summarised in a report “A Vision for Future Services”. However, this report
previously approved by the Board of the Trust and consulted upon, is reported by
the Trust, to have been superseded although no further comprehensive proposals
have been published.
2.0 PROPOSALS FOR RECONFIGURATION – KEY ISSUES
2.1 Details of the proposals for change are set out in the Clinical Services Review
Road Map. Essentially, they propose that all emergency surgical work be ceased
at Halton General Hospital and transferred to Warrington General. This averages
around 4.2 cases each day.
2.2 As a consequence of this shift, new capacity for elective (planned) surgery at
Halton Hospital will be created. About 75 additional cases each week can be
2.3 The proposed changes are reported to be based on best practice, clinical
effectiveness and service efficiency. They should also positively affect
recruitment and retention of key professional groups. In essence, by treating all
emergency surgical requirements in one place, greater expertise can be assured and
better patient outcomes delivered. In addition, by “protecting” elective services at
Halton General Hospital, fewer operations will be cancelled and efficiency will be
ensured. The surgical teams will be able to control care at all times, without the
imposition of unplanned emergency work. They will be able to plan admissions
and ensure adequate support is available.
2.4 Medical services, including the admission of emergency cases, will not be affected
by the proposals.
3.0 PROCESS FOR SCRUTINY
3.1 The paper agreed by the Hospital Trust Board was shared with partner agencies on
3.2 On 6th
November, the Scrutiny Panel met with Senior GP’s and PEC members of
Halton PCT. The Chairman of the PCT Board also attended.
3.3 On 25th
November, an informal meeting, open to all HBC members was attended
by senior representatives of the Hospital Trust and Halton PCT. Appendix 3
3.4 On 18th
December, the Scrutiny Panel examined evidence from:-
• Mr P Wake - Clinical Lead for Surgery, NCH Trust
• Dr T Rose - Medical Director
• Mr S Parry - CEO, Halton PCT
• Dr D Lyon - Clinical Governance Lead, Halton PCT
3.5 A range of informal discussions have taken place, with senior representatives of
both the Hospital Trust and Halton PCT during the period since the proposals were
3.6 A range of issues have been raised with the Hospital Trust and PCT. Further
scrutiny, including the PPB meeting, will address outstanding issues.
4.0 KEY FINDINGS OF THE SCRUTINY PANEL
4.1 The proposals in “Clinical Services Review – A Roadmap for our Hospitals’
Future”, represent contemporary thinking for hospital services. They appear to be
based on best evidence, a determination to modernise services, provide additional
capacity for the system and conform to the agenda for Patient Choice.
4.2 The proposals to focus emergency surgery at Warrington General Hospital, has
clinical merit. By ensuring the surgical team is well resourced with consultant
cover 24 hours a day, 7 days a week, better outcomes for individual patients can be
assured. This view is fully supported by all the clinical evidence we took.
4.3 The proposals to develop elective (planned) surgery at Halton General Hospital
have clinical merit. By protecting services, surgical teams will be able to ensure
greater efficiency in the use of beds and up to 75 additional surgical episodes each
week. The Trust will need to develop detailed plans for the change, which will
need to be quantified and the clinical outcomes subject to detailed evaluation.
4.4 Whilst medicine at Halton Hospital is not directly affected by the proposals, the
need for surgical support/opinion for medicine is recognised. We are satisfied
that, this position will not be compromised by the proposed changes. There will
be sufficient sub consultant cover at the Runcorn Site with 24/7 access to a
consultant opinion from the Warrington based team.
4.5 We are satisfied that support services, including pathology and radiology will be
adequate. Though we recommend the trust explore the development of
contemporary technological innovation, to support services.
4.6 The proposals, as currently developed, make only passing reference to whole
system working. In particular, we identify the need to develop intermediate care,
rehabilitation and support services. These developments are a key aspect of a
modern service, where patient choice is adequately supported by Primary and
Social Care Services. Whilst we had confirmation from the CEO of the PCT that
investment should be forthcoming, we would expect to see this commitment
confirmed in the Local Delivery Plan (LDP).
4.7 We believe the proposals constitute a substantial change to services. As a
consequence, we would expect the Trust and PCT to have thoroughly consulted
with public and patients. This is a requirement of the Health and Social Care Act
2001 – Section 11. This matter has been raised both by the CEO of the Borough
Council and Chair of PPB. It will be essential that consultation is shown to be
robust and meaningful. Future assurance on this matter is awaited.
Whilst not a specific part of the Clinical Services Review, the provision of 2 or
more intensive care beds at Halton General is a key issue. Whilst the Trust has
given an assurance that it is their intention to reopen the beds, they have failed to
action this. All clinicians interviewed by the Scrutiny Panel support the re-
opening of beds. This is critical, not simply for current service provision, but we
believe the medium/long term future of Halton Hospital as an acute service.
Evidence presented to us, highlights the cost and complexity of this matter. Given
the intention to sustain existing medical services, expand elective surgical services
and host a Private Finance Initiative on the Runcorn Campus, they should, in our
view, be re-opened without delay.
4.10 Whilst the Commission for Health Improvement may offer some guidance, the re-
opening of the ICU beds may well prove to be an internal matter for the Hospital
Trust. We will expect them to adhere to their stated aim, exercising the
management control required, to re-start the service.
5.0 AREAS FOR DEVELOPMENT AND DETAILED EXAMINATION
5.1 Access to hospital services at a local level is essential to people in Halton. Many
people in Halton rely on public transport. We do not believe this issue has been
factored in to the proposals. Future examination, with detailed arrangements must
5.2 In developing a comprehensive vision for future services, it is essential that the
Hospital Trust and Halton PCT develop comprehensive services across the whole
Health Community. The proposals for Clinical Services review, whilst substantial,
are only one aspect of a total provision.
5.3 In developing services, the focus on patient choice, and a local health service will
be important. For example, what opportunities will there be for improvements in
outpatient services at Halton? Will Halton people be able to access a wider range
of provision at their local hospital? These and other issues must form an overall
5.4 The proposals are based upon contemporary evidence and best practice. However,
the trust must now develop a detailed action plan, providing timescales for
implementation. This must be supported by clear processes to monitor and
measure the actual impact of the changes. To include capacity gained and
outcome for patients.
6.1 That whilst clinical evidence suggests that the proposals are well founded, they
will only be successful, within a context of a more comprehensive, overall
strategy, sensitive to the needs of the Halton community. Therefore, before
proposals can be endorsed, we seek confirmation from the Boards of The North
Cheshire Hospitals Trust and Halton’s PCT that the recommendations actions in
paragraphs 6.2-6.9 of this report are accepted, taken forward and progress reported
to a future PPB.
6.2 That North Cheshire (NCH) NHS Trust be recommended to explore and invest in
improved technology to support it’s two centre operation.
6.3 That NCH Trust and Halton PCT develop detailed care pathways to ensure that the
increased surgical capacity will be matched with appropriate, community based,
post operative care and rehabilitation.
6.4 That Halton PCT confirm the commitment of it’s CEO to invest in
rehabilitation/intermediate care/primary care services, and inter agency work with
6.5 That arrangements for public/patient consultation on the proposed changes
conform to the requirements of Section 11, Health and Social Care Act 2001.
6.6 That the two Intensive care beds at Halton Hospital are re-opened as soon as
possible. With plans to expand this provision as required being adequately
6.7 That the arrangements for transport are fully examined and planned for, as part of
the detailed action plan.
6.8 That NCH Trust provide a full action plan, supported by a framework for the
robust evaluation of the changes proposed.
6.9 That NCH Trust Board develop a clear long term vision for the Halton Hospital
Campus as a essential part of Acute and Medicine Services. This to ensure
appropriate health provision to the Halton community and to make best use of the
capacity available. The existing proposals being only one part of overall service
provision at both Primary and Secondary levels.
6.10 That the Hospital Trust provides some further clarification on their original report
- Vision of Future Services. In particular, explaining why many of its
recommendations have now been superceded.
7.0 CONCLUDING REMARKS
7.1 The Scrutiny Panel of:
Cllr T McInerney
Cllr J Stockton
Cllr M Massey
Cllr K Morley
Are grateful for the help and co-operation of colleagues from both North Cheshire
Hospital NHS Trust and Halton PCT.
Please note that these are not verbatim minutes and if you wish to make further
additions, please contact email@example.com
Clinical Services Review Meeting
North Cheshire Hospital’s Trust
Present: Mike Cuff HBC Diana Terris HBC
Cllr L Temple HBC Cllr E Cargill HBC
Cllr D Cargill HBC Cllr P Tyrrell HBC
Steve Coveney HBC Cllr J Swain HBC
Cllr K Loftus HBC Cllr J Devaney HBC
Jim Wilson Halton PCT Daniel Seddon HPCT/HBC
Cllr A H Taylor HBC Cllr M Massey HBC
Cllr P Lloyd-Jones HBC Cllr T McDermott HBC
Cllr F Fraser HBC Gill Cook HBC
G Moran Halton PCT Dr D Lyon Halton PCT
Mr M Frayne NCHT Cllr S Parker HBC
Cllr R Gilligan HBC Kath Holbrook NCHT
Dick Tregea HBC Cathy Edge HBC
Cllr T McInerney HBC Cllr J Morley HBC
Dr M Narayana Halton Cllr A Gerrard HBC
Ian Dalton NCHT Mr Phil Wake NCHT
Mr Paul Moody NCHT Cllr A Lowe HBC
Cllr E Jones HBC Mr Mark Tighe NCHT
Mr Barry Taylor NCHT
Apologies: Mike Hall PM Cllr M Wharton HBC
DerekTwigg PM Cllr Stockton HBC
Cllr A Cole HBC Cllr K Wainwright HBC
Stephen Parry PCT John Webb HBC
Cllr T McInerney welcomed the representatives from North Cheshire
Hospital’s Trust and Halton Primary Care Trust.
Cllr McInerney expressed his concern that Halton Hospital be best served
by North Cheshire Hospital’s Trust.
Ian Dalton, Chief Executive of North Cheshire Hospital’s Trust, thanked
Halton Borough Council for inviting him to this meeting.
Ian Dalton presented key points from the Clinic Services Review ‘A Road
Map to our Hospital’ Future’.
After discussions with Hospital Staff, Ian Dalton was concerned that they
did not have a clear clinical direction and with this in mind he re-visited the
‘Vision of Future Services’ document.
Ian Dalton confirmed that Halton Hospital will remain an acute hospital
offering a current range of specialities and that Speciality Services will not
be moving to Warrington. He also stated the Halton Hospital has an
excellent capacity and we should look at the Services offered by both
Hospitals and utilise them to their best. We need to ensure that:
1. Halton Hospital is secure as a major provider of services.
2. The Trust is up front with the public in what they intend to do
He also stated that the Trust wants to bring more elective surgery to Halton.
There is the capacity there and to offer people the choice to have their
surgery at Halton, rather than Warrington, if they wish. The Trust want to
centralise Emergency Surgical Services at the Warrington site.
The Local Clinical Perspective
Dr David Lyon, Clinical Governance lead, Halton Primary Care Trust gave
a presentation ‘Emergency Care for Halton’.
In a Surgical Emergency
We may require:
Rapid access to Experienced Staff
24 hour Operating Theatre
Cross Speciality Support
4 Emergency Admissions per day
1 or 2 Emergency Operations per day (30%)
3 Consultants on rota
Theatre is not open 24 hours a day
Gaps in Specialist Provision
Greater lengths of Hospital Stay
Closed to Admission 10% of the time
High Mortality Rate
(as highlighted in DoH documentation, death rate shown after surgical
admission with comparative units over a 3 year period)
Shorter Waits for Out-patients
Variety of Expertise and Skilled Specialists
Shorter Wait for Operations
Local After Care
Emergency Operations can contribute to cancelled operations and longer
stays in hospital.
Acute cases be moved to Warrington
24 hour dedicated Emergency Team
Full Support from other Clinical Teams and Diagnostics
Shorter Hospital Stays
Halton protected from Bed Blocking
Increased Number or Surgeons with a Wider Variety of Case Mix
An Attractive Proposition for New Staff
Better Training Opportunities for Junior and other Staff
(Halton Staff will rotate with Warrington)
Medical Admissions will not be affected
There will be a greater need for High Dependency Unit (HDU)
Major Expansion of planned Admissions would be possible
ITU would be more necessary for Medical Admissions
Rare for Surgical Admissions to require ITU bed
Dr Lyon stated that questions had been raised about the safety of the ITU at
Halton and that they are still awaiting the results of the Commission for
Health Improvement (CHI) assessment. We will not know what is going to
happen to the ITU until the CHI assessment results are available.
How will we know it works
Continue to Examine Mortality Rates
Reduced Lengths of Stay in Hospital
Number of Out-patients seen on Halton site
Assessing the Number and Types of Operations
Reviewing Waiting Times for Out-patients
Reviewing Waiting Times for Operations
Reviewing Number of Cancellations
Dr Lyon stated that the Acute Surgical Services for Halton Residents will
Planned Surgery at Halton will be expanded.
Hospital will be a vibrant and attractive place to work and learn in.
There will be no change for Medical Emergencies.
The Impact on Primary Care Services in Halton
Daniel Seddon, Director of Public Health and Health Strategy, presented
the Primary Care Trust Board’s point of view, on behalf of Stephen Parry,
of the Clinical Services Review.
Daniel Seddon agreed that there are positive benefits around focussing the
Surgical Emergency Services at Warrington, however, planned Surgical
Beds may still be taken by Emergencies and this is something that will
need to be worked at. Daniel Seddon stated that the PCT aim to promote
and improve health and there are three issues that we need to focus on:
b. Organisational Integrity
c. Health Benefits and Promises
Patients, staff and visitors will need to travel from Halton to
Warrington/Warrington to Halton sites for treatment on occasions and this
is an opportunity to look at Patient Transport Services as a whole. We do
not want to make the situation worse for patients. The NHS is a big
contributor to the traffic ‘chaos’ and we have a responsibility to the
Corporate citizens not to make this worse.
In the past there have been experiences of mixed messages being
communicated from within the organisation. Promises from the Board will
only be made when they are sure they can be delivered.
Health Benefits and Promises
PCT view from PEC is that these promises can be delivered. It is very
important that the delivery is actively managed and that expectations and
promises are confirmed by robust methods of evaluation.
Questions to Presenters and Hospital Team
Q. Cllr T McInerney stated that he understood that Halton was to be a
largely ‘cold’ site and that ITU beds would be required for Medical
Patients. He outlined concerns that had been raised in a letter by Surgeon,
Mr Jim Johnson, regarding the viability of services if the ICU beds are not
R. Mr Phil Wake, Surgeon Representative, replied that the Trust have no
problem about the ITU beds being re-opened and outlined the use of ITU
beds for Critical Care;
‘ITU is used for critical care for the critically ill patient. Most patients are
nursed on a normal General Ward. If they are less well and require more
monitoring and more technical expertise they could be transferred to the
Critical Care Unit namely a High Dependency Unit (HDU) or Intensive
Care Unit (ITU/ICU) bed. The majority of patients requiring Critical Care
are managed by the HDU spectrum of Critical Care. The number of
patients that require ICU are a relatively small percentage and most of these
come through as Emergency Patients. We would like to see this service
R. Dr Lyon responded stating that the PCT Commissioners would like to
see the ITU open as soon as CHI make its decision and hopefully this will
be within a reasonable period.
Q. Cllr L Temple outlined his concern that service users would have to
travel to Warrington to receive Emergency Services.
R. Daniel Seddon replied that the PCT/Trust hope to develop a reasonable
plan for both sites and that with the two sites together there would be
R. Ian Dalton stated that there were a number of patients already travelling
to Warrington for surgery and hopefully this would reduce the number of
journeys from Warrington to Halton. More patients would be treated
locally, less patients would have to travel. There are already 30 Halton
surgical patients currently treated at Warrington per week and that the Trust
would be happy to discuss ways of improving transport with the PCT.
Q. Cllr M Massey asked how Halton Hospital would be able to manage the
medical emergencies if it does not provide 24 hour services?
R. Ian Dalton replied that they were under extreme pressure at the moment
and did not think it was fair to assess them on the last few weeks. There
has been a particular spike of emergency cases nationally and other trusts
were also feeling the pressure at the moment. There is a Government grant
of £180,00 for looking at how best to manage patient resources. A big
pressure on surgery comes from medical emergency. Ian Dalton believes
these changes would be better for patients on both sites and did not think
they were in any way at conflict.
Q. Cllr D Cargill was concerned that the Trust had not considered the social
make-up and fabric of Halton. The Council was trying to improve the
status of Halton and he felt that services were being taken away from
Halton eg. Children’s Services. He was also concerned about the parking at
Warrington Hospital asked what endeavours were being made regarding a
suitable transport system for people travelling between the two hospitals?
R. Ian Dalton explained that Paediatric Surgical Services were removed
because of the safety issues. Children can only undergo surgery when a
Paediatric Anaesthetist is in attendance and other suitably qualified staff.
Halton does not have that back up available.
R. Kath Holbrook, NCHT – stated that the Trust are looking at which other
services we might be able to develop on the Halton site.
Q. Cllr Tom McInerney stated that a decision should be made as to whether
these Services are going to be put on the Halton site.
R. Ian Dalton replied that the Trust were not going to make promises that
they did not know they could deliver. He stated that the reality of the
Health Services is that expectations rise and the Services will change. He
stated that he could not promise that this process would reduce the need for
transport between the two sites and obviously this would be open to
discussion. However, if people want the Trust to give more this would be
at a cost which he thought would be hard to justify given the overall
financial position of the Trust. He would like to make sure that the
maximum is spent on patient care and that we have to be very clear about
our priorities but is open to debate about this.
R. Dr Narayana, GP Representative – stated that local doctors are in
support of this. He believes that if we delay further Halton is in danger of
becoming a very minor hospital. These changes will benefit the people of
Halton and we should support the proposals to improve the services.
Within the modern NHS there is a need for particular arrangements for
Specialist Services. Surgeons carrying out 200 specialist cases a year get
better results. Historically Halton has had ‘General’ type surgeons who
perform many different operations and we have to accept that this is not
acceptable any more and we will have to increase the number of Specialist
Surgeons available for Halton. The needs of the Halton population are very
great and we need this modern Surgical Team.
R. Mr Phil Wake, Surgeon Representative, - agreed that this is a very
exciting development. There is a whole range of things we can do. We are
talking about expanding the services and what we would hope to see is a
more controlled, planned service extending right across the board
performed by a much bigger Team. If there are more surgeons on site then
there is more choice and access for patients.
R. Daniel Seddon – stated regarding transport that we have to challenge the
process. The PCT has a responsibility to prevent illness and improve
health. We need to think about the effects of service change and look at
this as a community. The position we have is resolvable.
R. Cllr T McInerney agreed that transport is important but that is was not
going to be resolved tonight!
Q. Cllr S Parker raised his concern that there seems to be lack of
communication within the Trust and the PCT?
R. Ian Dalton replied that he has started an ‘open forum’ within Halton
where members of staff can come along and quiz him on any issues and
that he would be holding regular meetings with Chief Executives, Board
Members and GP’s.
Q. Cllr Mrs E Cargill was concerned that other services would also be
moved from Halton to Warrington Hospital.
R. Ian Dalton reiterated that he did not think it was in the best interests of
children to have their surgery at Halton Hospital.
Q. Cllr T McDermott asked for an explanation of the mortality figures and
stated that offering training and a more interesting environment for
surgeons was not addressing the wants/needs of the patients. He also stated
that Warrington patients were being given the choice to travel to Halton for
their treatment if they wished, but Halton patients were not being given that
choice and that Halton Borough Council, not having any representation on
the NCHT Board, could not influence this.
R. Ian Dalton replied that there is a National shortage of doctors and Halton
has a number of places that need to be filled and that it was essential to
offer a vibrant position with a wide range of training and services.
R. Mr Phil Wake, Surgeon Representative, stated that it was important to
note that they could not guarantee that these changes would reduce the
death rate in Halton. There could be a number of factors contributing to
these figures but some of the issues being addressed ie. specialist surgical
expertise, long stays in hospital could help to improve these figures.
Q. Cllr T McInerney asked if a patient could be put in mortal danger by
being driven to Warrington in an emergency situation when Halton
Hospital is much nearer.
R. Surgeon – replied that this situation is already happening as Halton is
not providing 24 hour theatre cover.
Q. Cllr P Lloyd-Jones asked for a further break down of the mortality rates
with a comparison to Warrington’s mortality rates and asked if there were
any proposals to increase the quality of care in Halton.
R. Mr Phil Wake, Surgeon Representative, replied that the Warrington
mortality figures were much better and that the information could be found
on the Department of Health’s website and that the changes that were being
suggested would help to improve care.
R. Ian Dalton replied that his clinical view was that patients would have a
better outcome if Emergency Services were centralised at Warrington.
R. Dr Narayana, GP Representative, agreed and stated that the poor
outcomes for emergencies could be due to there being on dedicated on call
surgeon. At Warrington there are dedicated surgeons.
R. Daniel Seddon added that the mortality rate information was actually
quite dated and that we need to look at this and see if there have been any
Q. Cllr P Tyrrell stated that the Council had been promised a decision
regarding the ITU in August of this year and were still waiting for that
R. Ian Dalton replied that he was not aware of this promise and that he
believed that CHI usually respond within 3 months but he was hoping for
further discussion with CHI next week.
Q. Cllr A Gerrard asked if there were any plans for working with Primary
R. Ian Dalton stated that they had key representation available for dialogue
with PCT’s and GP’s on this issue and a meeting is to be held on 12th
December to discuss Care Pathways bringing providers together to look at
each others practices.
Q. Cllr J Morley thanked the Medical Team for sparing the time to attend
the meeting and asked when the Trust were going to be consulting the
public regarding these proposed changes in service.
R. Ian Dalton stated that they were consulting the public by having this
discussion with the Councillors this evening and were happy to attend any
committees for discussions.
Q. Cllr T McInerney asked if there was a suggested time scale for the
transfer of services.
R. Ian Dalton replied that there was no time scale but in the interest of the
patients he felt this should be done as soon as possible.
Cllr T McInerney summarised that the Trust, the Surgical Team, PCT and
GP’s were in agreement that they felt this transfer of services should go
Cllr McInerney thanked the presenters for giving the Councillors the
opportunity to ask questions and hoped that there would be further
opportunities for discussion in the future.