Agenda item

To consider the attached report of the Head of Scrutiny and Member Development presenting the Scrutiny Board (Health) with additional information to assist members to consider current proposals associated with the provision of renal services (dialysis) across the Trust, particularly in terms of provision at Leeds General Infirmary (LGI).

The Head of Scrutiny and Member Development submitted a report providing Members with additional information to assist in the consideration of current proposals associated with the provision of renal services (dialysis) across the Trust, particularly in terms of provision at Leeds General Infirmary (LGI).

The report also presented the draft Yorkshire and The Humber Renal Strategy (2009 – 2014) for consideration and comment.

Appended to the report was the following information:

·  Position Statement: Proposed Renal Services Provision at Leeds General Infirmary – 29 July 2009 (Appendix 1)

·  Renal Services: Provision at LGI – Follow-up Questions – (Appendix 2)

·  Leeds Teaching Hospitals NHS Trust (LTHT) Response to Scrutiny Board Health follow-up questions on Renal Services provision at LGI (Appendix 3)

·  Draft Yorkshire and the Humber Renal Network Strategy for Renal Services 2009-2014 (Appendix 4)

Previously accepted as additional information under Agenda Item 3 (Minute No.40 refers) was a written submission from the Kidney Patients Association (LGI).

The Chair welcomed to the meeting, Frank Griffiths from the Kidney Patients Association (LGI), to outline the patients’ position on the proposed changes to renal provision at LGI.  Gloria Black, a kidney dialysis patient since 1996, was also invited to address the Board on her first hand experiences of undergoing dialysis at Seacroft.

Mr Griffiths submitted an apology from Paul Taylor of the Kidney Patients Association (St. James’) and read out a letter from Mr Taylor which endorsed everything that the KPA (LGI) were saying and supported their campaign to get renal services at the LGI fully reinstated.

Mr Griffiths then summarised the written submission from the KPA (LGI).  At issue was the way the LTHT had planned and provided care for patients with Chronic Kidney Disease.  He referred to a paper dated 29^th April 2009  from the National Kidney Federation (NKF) which provided a definition of a ‘patient centred service’, advice on how a site should be chosen and the other hospital services and departments that should be easily accessible to kidney patients.  The KPA was concerned that these recommendations were not being followed in Leeds.

Mr Griffith raised particular concerns about the Seacroft unit being described as a ‘Main Dialysis Unit’ by the Trust, although it did not have the service standards required by a main unit as defined in the aforementioned NKF paper.  Mr Griffiths later went on to expand on this issue and explained about co-morbidities, that is when a patient had more than one complaint for which they needed treatment, such as cardiology, neurology, eurology and diabetes – questioning how these services could be accessed at the main dialysis unit at Seacroft.

The NKF paper also defined holistic care and there was concern that the guidance on treating kidney patients holistically was not being met in Leeds.  The Seacroft unit had not been built for that purpose, doctors were not available on a regular basis there and neither was psychological support, faith observance support, nor the services of a dietician provided.

Mr Griffiths went on to express concern regarding the reliance on ‘clinical need’ to inform the planning and delivery of dialysis services: stating that clinical need was disease defined and not patient orientated.

Mr Griffith then went through the individual follow up questions that had been asked of the Chief Executive of LTHT by the Scrutiny Board (Appendix 3 to the report refers) and outlined the KPA’s views.  Of particular concern were:

·  That the patients felt they had been misled to believe that a unit would ever be delivered at LGI and they felt seriously let down. 

·  That the March 2009 patient survey had now been acknowledged by the Trust as of no help in the discussions on the location of haemodialysis. 

·  That the information on inward and outward journey times to and from Seacroft Hospital, as supplied by the LTHT in tables at Appendix 3 to the report (pages 45 and 47 of the agenda refer), should be withdrawn, as the journey times were obviously impossible to achieve and the data should be investigated.

·  That the impression given by the responses of the LTHT was that the LGI was not a popular location.

Mr Griffiths concluded that kidney patients deserved a better deal and that a promise had been made in 2007 by the Trust to re-establish a facility at the LGI and that promise should be honoured.

The Chair thanked Mr Griffiths and Ms Black for their address to the Board and invited comments from Members.  These were in brief summary:

·  That significant changes to previously agreed plans should have been referred back to Scrutiny, and they had not been.

·  Issues around the water plant at LGI and capital planning and maintenance schedules.

·  The impossible travel times to and from Seacroft Hospital, as supplied by the LTHT and the Yorkshire Ambulance Service (YAS).

The Chair then welcomed the following officers to the meeting to address the Board and respond to any specific questions identified by the Members:

·  Philip Norman, Divisional General Manager for Medicine – LTHT

·  Nigel Gray, Director of Commissioning & Development (Adult Services) –  NHS Leeds

·  Jackie Parr , Senior Commissioning Manager – Specialised Commissioning Group (Yorkshire and the Humber)

·  Sarah Fatchett, Director of Operations (Patient Transport Service) – Yorkshire Ambulance Service (YAS), and

·  Diane Williams, Assistant Director (Patient Transport Service – Communications) – Yorkshire Ambulance Service (YAS)

The issues discussed between Members of the Board and officers included in summary:

·  Communication - The Director of Commissioning and Development (Adult Services) acknowledged that communication between NHS Leeds, the patient groups and the Scrutiny Board had been poor and advised that new procedures would be put in place to ensure communication was improved.

·  Transport Data – The Director of Operations (Patient Transport Service) shared concerns raised regarding the data presented on travel times and acknowledged that it was flawed and personally apologised.  She explained that the technology was new and they were experiencing bugs with the operating software.  She agreed to rerun the data and provide the correct figures to the Board and the patient groups when it was available.

Members were given assurances by the Divisional General Manager for Medicine that the flawed transport data would not go to the LTHT Board. 

·  March 2009 Patient’s Survey - The Divisional General Manager for Medicine acknowledged that the information regarding the Leeds’ patients from the March 2009 patient survey was incorrect and would also be withdrawn from information presented to the LTHT Board.

·  Paper on Renal Services Provision to the LTHT Board - The Divisional General Manager for Medicine advised that a formal paper on the provision of renal services in the region would not be going to the December LTHT Board as they had to be certain that all the data was correct and that all the facts were present in order for the Board to make an informed decision.  It was not known when the paper would go to the Trust Board, but it would probably be considered before March. The paper would be on the provision of the entire service across the whole of West Yorkshire. Members were assured that any decision by the Trust Board would be based on clinical need.

·  Capital Replacement Timetable – In response to a question from the Chair asking what had changed since a clear commitment had been given in February 2009 to relocate 10 stations to a renovated area within LGI, the Divisional General Manager for Medicine advised that this was due to there being competing priorities in terms of the capital programme, for which there were scarce resources.  He advised that there was a clear capital replacement timetable, that no formal decision not to proceed with the LGI dialysis unit had been made and that the LGI dialysis unit had not disappeared from the capital programme.

·  SJUH Water Treatment Plant –The Divisional General Manager for Medicine advised that the proposal not to proceed with the planned dialysis unit at LGI was not based on an ‘either or’ discussion around the water treatment plant at SJUH. 

The Chair summarised that the Board was not satisfied with the rationale presented for revisiting the decision to establish a renal dialysis unit at LGI; nor how the prioritising of the water treatment works against other competing priorities had been explained.

The Chair thanked all the officers for their contributions and for attending the meeting and concluded that:

·  The case of current facilities being able to meet current and future demand had failed to be substantiated to the satisfaction of the Scrutiny Board;

·  The Scrutiny Board had been presented with misleading, inaccurate and conflicting information.  As such, the arguments presented to the Scrutiny Board around patient transport and the outcome of patient surveys had clearly been unravelled.

·  The Board would like to see the original LTHT commitment for this unit at the LGI to be reaffirmed and delivered. 

The Chair also suggested that, as there were clearly regional implications, as demonstrated in the draft Yorkshire and the Humber Renal Network Strategy for Renal Services 2009-2014, the Board needed to alert the other Health Overview and Scrutiny Committees across the region to this issue and consider any joint activity.

Taking all the above into account, the Chair stated that he would like to convey the Board’s concerns and observations to the Secretary of State for Health and this was agreed and supported by the other Members of the Board.

RESOLVED –

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

(b)  That the Board’s concerns and observations regarding this matter, including LTHT’s rationale for revisiting the decision to establish a renal dialysis unit at LGI, be conveyed to the Secretary of State.

(c)  That other Health Overview and Scrutiny Committees across the region be alerted to the regional implications, as presented in the draft Yorkshire and the Humber Renal Network Strategy for Renal Services 2009-2014, and consideration be given to any further joint scrutiny activity around this matter.

(Note: Councillor Lamb joined the meeting at the beginning of this item at 9.35am.  Councillors Iqbal and Illingworth joined the meeting during the consideration of this item at 9.55pm and Councillor Hollingworth joined the meeting during the consideration of this item at 10.05am.)

(The meeting was adjourned for a break at this point at 11.50am and reconvened at 11.55am.)