Agenda item

Further to Minute No. 55, 15^th December 2009, to receive and consider the attached report of the Head of Scrutiny and Member Development.

Referring to Minute 55 of the meeting held on 15 December 2009, the Head of Scrutiny and Member Support submitted a report presenting the responses to the statement and recommendations of the Scrutiny Board (Health) as agreed in December 2009.  The statement and recommendations were associated with the provision of renal services (dialysis) in Leeds, particularly in terms of provision at Leeds General Infirmary (LGI).

Appended to the report was a copy of a document entitled ‘Scrutiny Statement: Renal Services in Leeds (December 2009)’. As agreed earlier in the meeting (minute 78 refers), copies of the following documents were circulated at the meeting as supplementary information:-

• Yorkshire and the Humber Renal Network Strategy for Renal Services 2009-2014 Enclosure S2 – Draft Version – 19^th February 2010
• Yorkshire and the Humber Renal Network map

The following representatives were in attendance:-

Rosamond Roughton, Director of Strategy and System Reform – NHS Yorkshire and the Humber

Cathy Edwards , Director – Specialised Commissioning Group (Yorkshire and the Humber)

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

Martin Ford, Head of Commissioning (Long-term Conditions, Cancer and End-of-Life Care) – NHS Leeds

Philip Norman, Divisional General Manager for Medicine – LTHT

Judith Lund, Directorate Manager (Speciality Medicine) – LTHT

Dr Mark Wright, Clinical Director and Renal Consultant – LTHT

The Chair then allowed a brief verbal presentation from each of the following representatives regarding the provision of renal services (dialysis) and the issues highlighted in the Board’s statement and recommendations:-

Cathy Edwards, Director – Specialised Commissioning Group (Yorkshire and the Humber)

In summary, specific reference was made to the following key issues:-

• an update on progress in relation to producing a regional strategy for Renal Services, with an outline of the overall aims and core themes within the strategy, together with key actions and arrangements for monitoring delivery;
• the decision-making processes, including  key responsibilities of the Specialised Commissioning Group Board and Primary Care Trusts across the region, including NHS Leeds;
• an outline of service priorities, including West Yorkshire’s position with reference to ongoing discussions around renal dialysis provision in Huddersfield and Wakefield;
• the shortage of NHS capital to fund further capital projects.

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

In summary, specific reference as made to the following key issues:-

• An acknowledgement that collectively, the local NHS had failed to fully engage with the Scrutiny Board and other interested parties early enough in the process – for which NHS Leeds wished to convey its apologies;
• A range of important lessons to be learned, including the need for:

1. better communication and closer working with all relevant NHS bodies, including the Specialised Commissioning Group and Leeds Teaching Hospitals NHS Trust;
2. improvements to the processes for collecting and using patient transport data from Yorkshire Ambulance Service (YAS);
3. more robust processes for gathering and using patient survey information;
4. continued engagement with patients and patient group representatives, such as the local Kidney Patients Associations.

• Recent concerns expressed by the KPA about the level and quality of medical and nursing care provided to renal patients at Seacroft Hospital.  The Scrutiny Board was advised that a review of current arrangements had been jointly undertaken by senior representatives from NHS Leeds and the Specialised Commissioning Group (Yorkshire and the Humber).  As a result, service commissioners were assured that significant improvements had been made in relation to the concerns raised, and monitoring of the quality of care and services provided would continue. 

Philip Norman, Divisional General Manager for Medicine – LTHT

In summary, specific reference was made to the following key issues:-

• An acknowledgement that LTHT had failed to fully engage with the Scrutiny Board and other interested parties in a timely manner – for which the Trust wished to convey its apologies;
• Reiteration of the lessons learned previously identified by NHS Leeds (above) and a firm commitment for an improved approach in the future;
• That Recommendation 1 of the Scrutiny Board’s statement (i.e. in relation to the dialysis facility at the LGI) would be discussed at a future meeting of the Trust Board – likely to be 20 May 2010;
• Levels of available capital investment and the need for the Trust to consider the needs of all patients;
• Current levels of capacity for renal dialysis across Leeds, and in particular at Seacroft Hospital.

Rosamond Roughton, Director of Strategy and System Reform – NHS Yorkshire and the Humber

The Director of Strategy and System Reform opened her address by stating she had read the Scrutiny Board’s statement with increasing dismay and acknowledged that the events and processes had damaged the reputation of the local NHS.  In summary, specific reference was made to the following key issues:-

• Assurance that the issues highlighted by the Scrutiny Board’s statement would be considered by NHS Yorkshire and the Humber as part of appropriate accountability processes for both NHS Leeds and LTHT, including:

·  Foundation Trust assurance (in particular the Pubic Engagement and Financial Management domains);

·  The World Class Commissioning Programme and associated assurance processes.

• Support for the areas of improvement outlined by NHS Leeds and LTHT and a commitment for NHS Yorkshire and the Humber to contribute to making the process work.

The Chair thanked all those attending for their presentations to the Board.  The Chair went on to state that it was clear that the Scrutiny Board had significantly raised its profile since June 2009, having raised a number of concerns on behalf of the patient population of Leeds.  The Chair recognised that the Scrutiny Board’s statement had raised a number of concerns and highlighted a number of areas for improvement.  As such, the Chair welcomed the collective view and acknowledgement of the local NHS that significant improvements had to be made – particularly around engagement with the Scrutiny Board and, more importantly, patients and their representatives. 

The Chair then invited comments and questions from other members of the Board.  In summary, specific reference was made to the following issues:-

• The need to acknowledge that this had been and continued to be a major issue for the Board;
• Appreciation that there had been admissions made at the Board that processes in some areas had failed;
• Acknowledgement that the local Kidney Patient Associations had played a key and important role in the Board’s review;
• The need for the local NHS to acknowledge that there was a moral obligation to reprovide renal dialysis  provision at the LGI, with clarification sought around the recommendations likely to be made to the LTHT Board

(The Director of Commissioning and Development (Adult Services) NHS Leeds responded and advised that the NHS had a moral obligation to make the most appropriate decision – particularly in the context of the changing financial environment.  The Divisional General Manager for Medicine responded and confirmed that the report for the LTHT Board  had not yet been written)

• The continued need to ensure that people living in areas situated to the North and North West of Leeds City Centre were not disadvantaged by the location of dialysis provision across the City,  acknowledging that there was a major issue around the geographical location of Seacroft Hospital;

 (The Director–Specialised Commissioning Group responded and confirmed the need to consider access issues with a view to making improvements, which could include an expansion of home dialysis)

• Clarification of the long term plans around proposed changes to home dialysis, how such changes will be funded, how such changes may affect patients in the North and North–West of the City, and reasons why such arrangements had not been undertaken in the past.

(The Clinical Director and Renal Consultant responded and agreed to provide the relevant data for Board Members in this respect)

• The need for the Scrutiny Board’s Statement and Recommendations and the outcome of this discussion to be given due and proper consideration at the NHS Trust Board on 20 May 2010

RESOLVED-

a)  That the content of the report, appendices and information provided at the meeting be noted.

b)  To review the decision of the LTHT Board (expected on 20 May 2010) and consider any available options for the Scrutiny Board (Health) as soon as practicable at a future meeting of the Board .

(Councillor D Congreve left the meeting at 12.15pm during discussions of the above item)