Agenda item

To consider the attached report of the Head of Scrutiny and Member Development presenting the Scrutiny Board (Health) with a range of information to assist members to consider current developments associated with the provision of dermatology services, particularly in terms of inpatient provision on ward 43 at Leeds General Infirmary.

The Head of Scrutiny and Member Development submitted a report providing Members with a range of information to assist in the consideration of current developments associated with the provision of dermatology services, particularly in terms of inpatient provision on ward 43 at Leeds General Infirmary (LGI).

Appended to the report was the following information:

·  The response from Leeds Teaching Hospitals NHS Trust (LTHT) to the letter sent by the Chair of the Scrutiny Board (Health) requesting information and seeking clarification on various matters (Appendix 1).

·  Examples of communications sent by a range of stakeholders to LTHT (Appendices 2 and 3).

The Chair advised that the Scrutiny Board only became aware of potential changes in the provision of dermatology services, particularly in terms of inpatient provision on ward 43 at LGI, in early October when two separate requests for the proposals to be examined in more detail had been received from patients and the British Association of Dermatologists (BAD).

The Chair welcomed to the meeting:

·  Tania von Hospenthal, Business  Manager (Clinical  Advisory Unit) – British Association of Dermatologists (BAD)

·  Victor Boughton – Dermatology Patient Representative, and

·  Mohammed Patel – Dermatology Patient

Apologies had also been received from Andrew Langford, Chief Executive, Skin Care Campaign, who had provided a written submission and from Mark Goodfield, President of the British Association of Dermatologists.

The Board heard that one of the main concerns of BAD was the consultation process; that staff and patients should be consulted before any decision to move ward 43 was made.  BAD had written to the Chief Executive but had not yet received a response. They were also concerned that if the ward was to be moved, that it should remain as a dedicated unit and not be part of a larger ward.

The Dermatology Patient Representative summarised the comments received from patients and which had been accepted by the Board as additional information.  He outlined the anxieties of the patients if the ward became part of a larger ward; that the patients’ conditions would become worse due to stress unless the correct level of privacy and highly skilled nursing care was provided.  There were concerns about:

·  Contracting infections on open wards;

·  The availability of baths or showers – which were a necessary part of the daily treatment; 

·  The potential need for having to travel between different hospital sites for associated treatments, and the increased stress for patients this may cause;

·  The level of consultation with staff and patients.

Mr Patel, a dermatology patient on ward 43, then addressed the Board from a sufferer’s perspective and explained the effect on himself if ward 43 was to be moved and became part of another ward.  One of his main concerns was that the current high level of service would not be maintained outside of a dedicated ward for skin patients.

The Chair thanked the previous speakers for their views and then welcomed the following officers to the meeting to present the report and respond to any specific questions identified by the Board:

·  Philip Norman, Divisional General Manager for Medicine – LTHT

·  Graham Johnson, Divisional Medical Manager for Medicine – LTHT

·  Judith Lund, Directorate Manager for Specialty Medicine – LTHT, and

·  Ruth Middleton, Head of Commissioning (Planned Care) –  NHS Leeds

The officers explained to the Board that at present ward 43 had 14 beds, four of which were for rheumatology patients.  It had always been proposed to move the four rheumatology beds to St James’.  It was considered that the ward was unsustainable as a ten bed unit and this, along with the fact that, in the future, the ward would be isolated with no out of hours medical cover, was the reason for having to look at where the dermatology service could be provided elsewhere.  An options appraisal was currently being carried out to this end. 

The Divisional General Manager for Medicine also advised that it had been the LTHT’s intention to engage and consult, however first informal conversations with consultants and nurses regarding the provision of broader clinical services had spiralled to include discussion about the dermatology ward. 

The Directorate Manager for Specialty Medicine outlined the list of criteria that had been drawn up by the consultants for suitable alternative locations for ward 43 which would be used in the options appraisal paper.  They were also keen to work with Professor Cunliffe (a former consultant and now a patient in the dermatology department) to form a patient panel.

The Chair sought assurances that full consultation should take place on the future of dermatology services. The Board were assured by the Directorate Manager for Specialty Medicine that the consultation would be an open and transparent process.

With regard to concerns that some correspondence had indicated a move of only six inpatient dermatology beds and that other communication had indicated the provision of dedicated dermatology beds within a larger 22/24 bedded ward, the Divisional General Manager for Medicine assured the Board that at present their criteria was to provide ten dermatology beds on a dedicated ward.

Members made the following comments and raised the following questions:

·  That the Board was not averse to change but it was concerned again about the lack of consultation by LTHT with the stakeholders.

·  That the changes represented a substantial variation in service and as such there should be a 12 week period of consultation, in which the Scrutiny Board should be included.  Substantial variations also could not be looked at in terms of money but on the basis of clinical need.

·  That the LTHT did not seem to have a strategy or procedure for consultation.

·  Concern that the Chief Executive LTHT had indicated that ward 43 was not suitable as a ward and would be turned into office space.

·  Despite the assurances given at the meeting, it seemed that a decision had already been taken to move services from Ward 43.

The Chair stated it should be made clear that the Scrutiny Board was not averse to change, but an emerging theme for the year to date, seemed to be around how changes were proposed and progressed. 

The Chair summed up that this issue should come back to the Scrutiny Board to ensure that the commitments given by LTHT regarding the consultation process were taking place.  He also advised that the Board would write to the Chief Executive of LTHT seeking clarification on some of the issues raised at the meeting and to seek assurance that no decision would be made on the future of ward 43 until full consultation had been carried out.

RESOLVED –

(a)  That the contents of the report and appendices be noted.

(b)  That the provision of dermatology services be added to the Scrutiny Board (Health)’s work programme for future consideration.

(c)  That the Chair write to the Chief Executive of LTHT on behalf of the Board to seek clarification on some of the issues raised at the meeting and to seek assurance that no decision would be made on the future of ward 43 until full consultation had been carried out.

(Councillor Iqbal left the meeting at 12.20pm during the consideration of this item, and Councillor Kirkland left the room at 1.20pm at the conclusion of this item for the remainder of the meeting. Councillor Bentley left the room at 1.45pm but returned later in the meeting.)

(The Board adjourned for lunch at 1.20pm and the meeting reconvened at 1.45 pm.)