Issue - meetings

To consider a report from the Chief Accountable Officer, Stockport Clinical Commissioning Group.

The purpose of this paper is to provide Stockport Health & Wellbeing Board:

·         An update on the current situation in relation to the breast service at Stockport NHS Foundation Trust; and

·         A progress report on the transfer of commissioning of Breast Services to neighbouring NHS Trusts.

·         The primary aim is to ensure that local residents continue to have timely access to high quality Breast Services. 

The Board is invited to comment on and note the proposal.

Officer contact: James Brown, Stockport CCG, 0161 426 9900

A representative of the Chief Accountable Officer, Stockport Clinical Commissioning Group (CCG) submitted a report (copies of which had been circulated) providing the Board with an update on the current situation in relation to the breast service at Stockport NHS Foundation Trust including progress with the transfer of commissioning of Breast Services to neighbouring NHS Trusts to ensure residents had timely access to high quality Breast Services. 

It was stressed that the proposals would not affect breast screening but related only to breast surgery. It was also confirmed that the service was closed to new referrals in May.

The Chair reported that the Greater Manchester Joint Commissioning Board had begun a process for reviewing Breast Services across the city-region with a view to commissioning services differently to improve quality and addressing shortages of specialist staff. It was highly likely that Stepping Hill Hospital would have lost these services in the future.

The following additional comments were made/ issues raised:-

·         While the proposals were regrettable, but necessary to ensure access to safe and quality services.

·         Difficulties in delivering the service had arisen due to staffing shortages in in breast radiology that was reflective of a national trend and experienced  by other trusts that did not provide screening services.

·         The support to the Foundation Trust from the CCG and Council, including  from the Adult Social Care & Health Scrutiny Committee was welcomed.

·         Staff had been transferred and had worked hard to manage patient transfers. All those involved had worked closely together in the best interest of patients.

·         It was important that patients were empowered to make decisions about which hospital service was best for them.

·         The experience in General Practice had been of very little disruption and the process for the new pathway had been managing well.

·         While some patients may have to travel further, in comparison to access elsewhere in the UK it compared favourably.

RESOLVED – That the report be noted.

To consider a report from the Chief Accountable Officer, Stockport Clinical Commissioning Group.

The Scrutiny Committee will be updated on breast services.

Officer contact: James Brown, Stockport CCG, 0161 426 9900

Gillian Miller (Associate Director of Commissioning) and James Brown (Head of Communications) from Stockport Clinical Commissioning Group (CCG), accompanied by Sue Toal (Chief Operating Officer) and Claire Woodford (Director of Women, Children and Diagnostic Services) from Stockport NHS Foundation Trust (FT), attended o present a report (copies of which had been circulated) outlining a proposal for the CCG to transfer commissioning of Breast Services to neighbouring NHS Trusts on a permanent basis in light of ongoing challenges experienced by the FT with ensuring appropriately specialist staff. In the FT’s assessment, the service as currently commissioned was unsustainable and would become unsafe.

The following comments were made/ issues raised:-

·         Concerns were expressed the long-term impact of the closure of the service on breast care for women in Stockport. Councillors stressed the importance of continuity of care and the co-location of treatment and diagnostic provision. In response, it was confirmed that the proposal would be for patients to receive all treatment at the specialist site. It was also commented that this proposal needed to be seen in the wider reform context and the likely concentration of service provision in fewer, specialist sites.

·         Councillors expressed concerns about access to services and screening at non-Stockport locations, particularly for those needing to use public transport. Particularly concern was expressed that women would be deterred from undertaking screening. In response it was clarified that the proposals under consideration would affect specialised breast services only, not routine preventative screening arrangements, although it was conceded that there had been challenges with access to these facilities in the past. Previous consultation had sought feedback on access and transport from current patients, and no adverse comment had been received, but views would be sought as part of the upcoming engagement process. Further comment was made about it being undesirable for vulnerable patients being reliant on long distance public transport after appointments for invasive treatment or receiving difficult news.

·         Disappointment was expressed that this service would no longer be provided from the local hospital. In response the concern was echoed, but comment was made that at least one of the alternative providers was a centre of excellence and recognised nationally for its services, so residents were being provided with the best possible alternatives. It was further commented the model being proposed was the direction of travel for many specialist services to ensure their sustainability. Support was expressed for the principal of specialisation and concentration as a means to improve outcomes and reduce risk.

·         Concern was expressed that both Healthwatch Stockport and Healthwatch Manchester were aware of possible problems with capacity at Wythenshawe Hospital to be able to respond to the increased demand, with some clinicians blaming challenges at Stepping Hill Hospital despite having achieved specialist hospital status as part of the Healthier Together Programme. In response it was stated that Manchester University NHS Foundation Trust (of which Wythenshawe was a part) were achieving their cancer target whereas Stepping Hill were not, and Stepping Hill was successfully implementing the Abdominal Surgery services as part of the Healthier Together programme, providing very good service and outcomes, and attracting good staff.

·         In relation to potential challenges caused to Wythenshawe Hospital, it was commented that should these proposals go forward, a detailed delivery plan would be developed with the Trust. Previously, the Trust had had to respond to the suspension of the Breast Service in an unplanned way, but that this proposal would involve transferring staff and would thereby increase capacity. It was also confirmed that no direct complaints had been received.

·         There was discussion about the challenges of recruiting suitably trained radiographers and in maintaining appropriate staffing levels in services where there were shortages of specialist staff.

·         A number of councillors expressed disappointment about the need to cease services, the need for appropriate funding for the NHS and for measures to train and retain suitable staff.

·         Reference was made to the recent announcement of  ...  view the full minutes text for item 4