Agenda item

Dr. Suneil Kapadia (Medical Director) and Mark Brassington (Chief Operating Officer) from United Lincolnshire Hospitals Trust will attend the meeting.

The Chairman welcomed Dr. Suneil Kapadia and Mark Brassington, the Medical Director and Chief Operating Officer respectively, from United Lincolnshire Hospitals Trust (ULHT). The ULHT representatives had been invited to the meeting to talk about the closure of Grantham hospital’s accident and emergency department between 6:30pm to 9am for a period of 3 months from Wednesday 17 August 2016.

The presentation began by providing the national context: that there was a shortage of trained doctors to work in accident and emergency departments. To keep three A&E units open 24 hours a day, 7 days a week, it was recommended that there should be 24 consultants and a minimum of 28 middle grade doctors. ULHT had budget for 15 consultants and 28 middle grade doctors. Across the three A&E departments at Lincoln, Boston and Grantham 14 consultants (10 of which were locums) and 12 middle grade doctors were in place. The presentation included a breakdown of the number of doctors at different grades across the three sites, highlighting the number of substantive staff members and the number of locums.

Members were also given comparator information on patient attendances and admissions, including information from hospitals run by neighbouring trusts. These figures showed that the number of patients presenting at Grantham hospital on a daily basis were lower than at either of the other ULHT sites, Peterborough Hospital, Sherwood Forest Hospital and Nottingham University Hospitals.

In making their decision, ULHT had determined that reducing the opening hours at Grantham hospital was the safest option for all of Lincolnshire. The decision was supported by the clinical commissioning groups, NHS England and NHS Improvement. In reducing the number of hours at Grantham, capacity was made available to support Lincoln hospital. The ULHT representatives stated that in taking the decision, consideration had also been given to the other facilities and specialisms that were available on each site. While all three sites had access to anaesthetists, only the Lincoln and Pilgrim sites had intensive care consultants. It was noted that Lincoln hospital was also a designated trauma centre, so reducing resource there was not practicable. The assessment that ULHT made also took account of patients that would automatically be diverted from Grantham hospital even if the A&E department had been open 24-hours a day.

The representatives from ULHT also talked about the difficulties they had experienced in recruiting staff. Intensive work was underway to recruit doctors, with the Trust looking both in the UK and abroad, attending conferences and recruitment fairs. The Trust was also offering a programme where A&E doctors would be able to work part-time while studying part-time for a fully-funded Masters degree or PHD. The financial drain caused by recruitment was recognised, with agencies receiving a payment of £10k for each doctor recruited.

Members of the Council were given the opportunity to ask questions of the representatives. A number of speakers referred to the value in which Grantham hospital was held by residents in Grantham and the surrounding towns and villages. A number of members questioned the justification of the removal of doctors from Grantham on safety grounds. Several  Members referred to the growing population of Grantham and asked how the loss of the A&E service in Grantham could make things safer for residents in the town. A request was made that the risk assessments on which the decision was made should be shared. Members of the Council were advised that all of the documents on which the ULHT Board’s decision was based were publicly available and could be shared. Some members highlighted that the closure of Grantham hospital might constitute the ‘least-worst’ option, but that did not make it acceptable.

Other Members talked about the financial aspects of the decision, clarifying through their questions that the Trust had funding in place for their desired 15 consultants and the costs of using locums in comparison to permanent staff members.

Further comments and questions raised by Members reflected their concerns that the part-time closure was a pilot for a permanent reduction in services and asked about the Trust’s sustainability and transformation plan. Members were advised that this was due to be published from October 2016 and while services had to be sustainable, the ULHT board was clear that each of the three hospital sites had a future. 

The representatives from ULHT reiterated that within the county, Lincoln and Boston Pilgrim were the major sites, with intensive care and surgery services that were not available in Grantham. By diverting patients from one of the other sites to Grantham would mean that they could not receive the specialist care that they needed because those wider support services were not available. One Member questioned the impact of the closure on the ‘golden hour’ when alternative sites were approximately one-hour away. Members were reminded of those most serious conditions for which patients would automatically be taken Lincoln or Boston. While the speed of treatment was one factor, the right expertise had to be available to deliver it; this expertise was not available in Grantham. Reference was made to professional guidance that said if a patient was within 45 minutes of a major trauma centre, the local hospital should be bypassed. This guidance was now being extended to 1 hour.

Interest was shown in what additional support was provided in Lincoln and Boston as a result of the overnight closure in Grantham and whether it meant that there was a consultant on duty, on-site overnight. A breakdown of the on-site arrangements for consultants was provided that indicated that to provide a 24-hour a day consultant presence would require 16 to 18 consultants per A&E department.

The ULHT representatives advised Members that work was underway with clinicians at Grantham hospital to create pathways for admitting patients with existing conditions where a visit to A&E would not be necessary to admit them. It was hoped that would keep as many patients in Grantham as possible.

The Chairman thanked Dr. Kapadia and Mr. Brassington for attending the meeting and answering members’ questions.