Four separate and independent groups of clinical experts have advised central Lancashire’s health and care system that it must change the way the local services are configured if it is to continue providing safe and high quality care. The findings, which have been published today, come as the local NHS and council bodies across Chorley, Preston and South Ribble continue to work together on what is referred to as the ‘Our Health Our Care’ programme.

Through this programme of work, local health and care staff, together with members of the public and various other partners, have developed a range of options for how services could work differently in the future.

These options focus on hospital services across Preston, Chorley and South Ribble, but also look at how services provided away from the hospital (such as family doctors, community nursing and others) could work alongside hospital services in the future. The ultimate aim of these options is making sure local people get the right care, at the right time, from the right team and in the right place.

Panels from the Royal College of Emergency Medicine, the Greater Manchester, Lancashire and South Cumbria Clinical Senate and the Lancashire and South Cumbria Care Professionals Board have all independently reviewed the current arrangements and the suggested options for change. Clinicians from within the central Lancashire health and care system have also undertaken further scrutiny of the options too, with their conclusions also published.

The key question all of these expert clinical bodies sought to answer in their analysis was which options are the most clinically viable and would make sure patients are able to get the safe, high quality care they should expect.
The four separate reports all strongly advise that changes are required to the current arrangements and to summarise, all conclude in their own views that:

The Our Health Our Care programme has considered and proposed all possible options for change, taking into account recognised best practice clinical standards and guidance. Neither the current arrangements for emergency care or possible reinstatement of a 24hour A&E at Chorley and South Ribble District General Hospital are viable in the long-term, due to neither option being compliant with essential clinical standards. This is because other key services required to support an A&E department, such as emergency surgery and paediatrics (specialist care for children and babies) have historically not been provided at Chorley and South District General Hospital.

Critical care services (currently operating at both hospital sites) would be better located at the Royal Preston due to the often low number of patients at Chorley and South District General Hospital who require this level of care. The Royal Preston Hospital is designated, by NHS England, as the Major Trauma Centre for the whole of Lancashire and South Cumbria. This means that anybody living in this region who suffers a life threatening injury or illness will be taken to Preston for treatment because all of the specialist staff their condition requires are in the same place and able to provide the expert care required.

In their view, the Clinical Senate felt that the current critical care service at Chorley sees ‘one of, if not the lowest’ number of patients in the country and therefore does not make the best use of the clinical staff required to run the department at Chorley. They also felt that the skills and expertise of these staff would be better utilised if the critical care service was located in one place – which would have to be the Royal Preston due to the Major Trauma Centre designation. This is reflective of much research into the hugely positive impact major trauma centres have had on survival rates since being established in 2012.

There needs to be more alternatives for care in the community, away from the hospital, which local people can access and thus reduce the demand on hospital services.

The findings further endorse what local people have said they want to see. Through a variety of conversations and market research undertaken with local residents, the Our Health Our Care programme found:

• 85 per cent of local people felt the NHS needs to change to meet future needs.

• 93 per cent would be happy to see changes at their local hospital if it meant improvements to the quality of care offered.

• 80 per cent preferred the option of having hospitals specialised in certain kinds of treatments.

• 86 per cent agree that long-term health conditions are better treated either in the community or at home rather than in hospital.

• 79 per cent would be willing to travel further to receive the best care.
Despite the expert recommendations received, a number of options for change remain on the table. The viability and benefits of all options is continuing to be assessed. However, it is important to note that:

• None of the proposed options suggest closing Chorley and South Ribble District General Hospital.

• All of the options would mean that urgent care continues to be provided at Chorley, 24 hours a day, 365 days a year.

• No decision about the options will be taken until after a formal public consultation has taken place.

Speaking upon the publication of the reports, Denis Gizzi, Chief Officer of the central Lancashire NHS Clinical Commissioning Groups said: “I think local people and wider stakeholders would feel it is only right we seek independent, external assessment of the proposed options for change from expert clinical bodies such as these.

“Whilst these reports are obviously very important pieces of work they are only part of a wide range of evidence and assessments which we have made to date; and will continue adding to as we carry on looking at all of the possible options for change. No options have been ruled out at this stage and no option would be implemented until a full, open and fair consultation has taken place.”

Karen Partington, Chief Executive at Lancashire Teaching Hospitals NHS Foundation Trust said: “These reviews involved each clinical body visiting central Lancashire to speak to dozens of staff at both hospitals, who offered their own experiences and opinions around working at both sites, backed up by the clinical data they provided.

“We will continue to work with all of our partners through the OHOC programme to assess all of the options for change, with the ultimate aim of making sure our hard working, dedicated staff are able to use their skills to best effect and provide the highest possible standards of care for local people.”