Agenda item

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 reductions in funding to the Stockport Car Scheme that provided safe and affordable transport for patients in Stockport.

·         Confirmation was sought on whether staffing being transferred would have their current conditions protected, particularly in view of the need to retain staff. In response it was stated that there was continuous monitoring and engagement of staff, who were understandably upset at the possible closure of their service. Tribute was paid to their efforts to maintain service provision for the benefit of patients. Assurance was give that the TUPE arrangements would protect many of their terms of employment should they move to new providers.

·         Clarification was sought on whether the recommissioning of services would increase costs for services in Stockport. In response it was clarified that the proposal was to recommission with NHS providers, governed by existing tariff arrangements so there should be no increase in the cost of the service, although some costs would be incurred in expanding or modifying that provision.

·         Concern was expressed that changes would disproportionately impact the least well off in the community (those lacking transport, social support network). In response it was acknowledged that those from the most deprived areas tended to access screening and other services less often and so had poorer outcomes. Comment was also made that the feedback to the consultation may be weighted toward responses to more affluent communities and the under-representation of the more vulnerable and deprived communities and that this needed to be factored into the analysis of engagement feedback.

·         Clarification was sought on ongoing treatment and follow-up for patients previously or currently under the care of Stepping Hill Hospital and what steps were being taken to ensure they did no ‘fall through the net’. In response, the responsibility for the ongoing monitoring of these patients was acknowledged and the need for the Trust to manage this in the future. In was confirmed that the Trust had already undertaken work with existing patients about future treatment and care.

RESOLVED – That the report be noted and Gillian Miller, James Brown, Sue Toal and Clarie Woodford be thanked for their attendance.