Last week I took two chances to quiz health bosses on the plans for Cheltenham General. As you’re probably aware, local health trust bosses are now running a period of public engagement, before a formal consultation. There are fears that the A&E department may be lost.
The first meeting I attended was at Cheltenham Borough Council’s overview and scrutiny committee. I asked if reopening Cheltenham’s A&E department fully 24/7 was being ruled out. I was told that it had not been ruled out.
Just 14 hours later I went to Shire Hall to attend the Health Overview and Scrutiny Committee as a public questioner. I submitted a list of questions in advance of the meeting and received answers. I’ve posted them below. Please let me know what you think:
1. Please confirm how many A&E patients are seen in any one day in Cheltenham?
On average, 140 patients per day were treated at Cheltenham Emergency Department between April 2018 and March 2019. This includes patients that arrived between 8pm and 8am when the unit operates as a nurse led walk-in service. By way of comparison, Gloucestershire Royal Hospital Emergency Department treated an average of 280 patients per day. There are of course peaks and troughs throughout the week and year so averages need to be treated with caution.
2. Please confirm how many ambulances are sent to Cheltenham in any one day?
On average of 23 ambulances per day were received by Cheltenham Emergency Department between April 2018 and March 2019. By way of comparison, Gloucestershire Royal Hospital Emergency Department received an average of 80 ambulances per day.
3. Please can you confirm the average number of beds available in Gloucestershire Royal’s Accident and Emergency by 8am.
GRH A&E Department is an ambulatory care environment and as such there are no beds within the department; there are trolleys; we do not routinely record the number of empty trolleys in ED at 8am as it is so variable. Occupancy for inpatient wards is captured in line with national methodology i.e. a midnight census and the average occupancy for inpatient wards for the period April 2018 to March 2019 was 91.46%.
4. One doctor working in Gloucester has come out stating that Gloucestershire Royal Hospital could not cope with the additional burden of patients if Cheltenham Hospital was downgraded again. Why do you disagree?
The outcome of the current engagement programme, and public consultation process that will follow, will inform the final decision on a preferred option for the services being discussed under the Fit for the Future programme. Any changes to services would be subject to robust business case proposals which would include clear demonstration that service demand and capacity will be appropriately aligned to ensure no deterioration in service quality. In the case of a significant change, implementation would likely take a number of years due to the need to ensure buildings, equipment, technology, staff and money in place.
5. The statement from the Trust to the media stated that “no decisions have yet been made and any significant proposals for change would be subject to a full consultation process.” Can you therefore confirm that the extraordinary level of dissent already expressed by these proposals will be taken into account, and that one option on the table will be to retain Cheltenham’s A&E services and even to re-open the service to be a true 24 hour A&E again?
The options that will proceed to consultation next year have yet to be determined as they will be informed by the ongoing engagement programme. The purpose of an engagement programme is to develop plans together and we have scheduled many opportunities to do this throughout the next few months via our engagement events, our engagement hearing and the planned citizens’ jury. The engagement hearing, for example, is an opportunity for organisations to come and present alternative ideas for the provision of urgent care and hospital services that will deliver the very best care and meet the needs of everyone in Gloucestershire. Members of the public will be consulted on any significant changes that develop from this engagement programme.
6. We are told that, were Cheltenham A&E to be downgraded, it could turn into a GP led UTC. Please outline what this would entail and whether this would lead to no walk-in services being available.
The options that will proceed to consultation next year have yet to be determined as they will be informed by the engagement programme. The purpose of an engagement programme is to develop plans together and we have scheduled many opportunities to do this throughout the next few months via our engagement events, our engagement hearing and the planned citizens’ jury. The engagement hearing, for example, is an opportunity for organisations to come and present alternative ideas for the provision of urgent care and hospital services that will deliver the very best care and meet the needs of everyone in Gloucestershire. However, we see both Cheltenham General and Gloucestershire Royal Hospitals as continuing to provide a range of same day, walk-in urgent care services 24 hours a day, 7 days a week for local patients and we do not anticipate this being on the basis of solely a booked appointment, but one of the things we are talking to the public about is whether they would value the opportunity to book an appointment on some occasions, for some conditions, to avoid an uncertain waiting time, for example. Members of the public will be consulted on any significant changes that develop from this engagement programme.
7. When announcing the delay in starting the “engagement” over Cheltenham A&E’s future, you referenced that this was in part because of “feedback [you] received from some of [your] stakeholders”. Who were these stakeholders and what privileged information did they receive in advance of other key stakeholders such as the councillors in this scrutiny committee?
We had discussions with NHS England about the nature of the engagement process as Stakeholders told us that despite our best efforts, there was still some confusion in peoples’ minds about the difference between engagement and consultation. We have strengthened this aspect of the booklet.
8. How many times, since 2013, has Gloucester missed the four hour target for A&E waiting times?
Between 2013 and 2016 Gloucestershire NHS FT was a poorly performing Trust against the national 4 hour standard. In August 2016 GHFT was subject to regulatory action and received undertakings relating to Urgent and Emergency Care performance from NHS Improvement. The Gloucestershire health and social care system initiated a number of interventions which improved performance dramatically and sustainably from early 2018. We validate and submit data as a single organisation (GHFT) and not in a site specific manner to NHSI / E and in all four quarters 2018/2019 the System delivered against our agreed 90% trajectory. We continue to focus on a programme of work to deliver performance improvement and in 19/20 we continued this delivery against agreed trajectory in Q1 and are on track for success in Q2. We now report as Gloucestershire ICS, and this ensures that all activity is captured and accurately reflective of urgent care activity across the whole System. Gloucestershire ICS was the top performing System nationally for performance against the 4 hour standard in the most recently published month of June 2019 and regularly sit in the upper quartile nationally.
I also asked one additional question, because I wanted a guarantee that reopening our A&E would be an option when the consultation happens. No guarantee was given.
I thank the local health bosses for answering the questions and fronting up. While they’re the ones in the firing line, we can’t forget that the NHS is in this position due to the Conservative party’s policy of starving the health service of the funding needed. You can read more about the Liberal Democrat policy for the health service here.