Agenda item

To consider a report of the Head of Scrutiny and Member Development updating the Board on the progress of the national review of children’s neurological services in England

(report attached)

The Board considered a report of the Head of Scrutiny and Member Development providing background information around the national Review of Children’s Neurosurgical Services.

The Board also considered written submissions from Safe and Sustainable review team (provided via Yorkshire and the Humber Specialised Commissioning Group) and Leeds Teaching Hospitals NHS Trust.

The Board welcomed the following representatives who attended for this item:

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

·  Stacey Hunter (Divisional General Manager, Children's Services) – Leeds Teaching Hospitals NHS Trust 

·  Dr Colin Ferrie (Consultant Paediatric Neurologist) – Leeds Teaching Hospitals NHS Trust

·  Dr Jeff Perring (Director for Paediatric Intensive Care Unit (PICU) and Medical Lead for Embrace) – Sheffield Children’s Hospital

·  Alison Hollett (General Manger, Critical Care Directorate (which includes Embrace)) –  Sheffield Children’s Hospital

·  Dr David Macklin (Associate Medical Director) – Yorkshire Ambulance Service (YAS)

The Director of Yorkshire and the Humber Specialised Commissioning Group (SCG) introduced the item, highlighting the following points:

·  This was a national review being undertaken as part of the Safe and Sustainable programme;

·  The review involved the following 3 key workstreams:

(i)  Setting up Children’s Neurosciences networks

(ii)  Procurement of additional complex surgical treatments, particularly around epilepsy surgery

(iii)  Establishing a multi disciplinary team (MDT) approach for rare and complex brain tumours

·  The review was a standards based approach – identifying agreed standards of care to ensure consistency across the country.

·  A significant amount of work had been undertaken in preparing the draft standards, which would be made available shortly for comments.  On publications, the period to provide comments would be 3 months.  There would be further opportunity for workshops with parents and other key stakeholders, alongside a web-based questionnaire to help gather comments.

·  Following comments on the standards, SCGs would be responsible for establishing the configuration of neurosciences networks – likely to be completed by June 2012.

·  Implementation of the new arrangements was targeted for the beginning of 2013.

It was highlighted that some priority work areas included ensuring 24/7 medical cover, robust data collection, arrangements for image sharing and governance arrangements for networks.  It was also reported that there were significant links with the major trauma arrangements discussed elsewhere on the agenda.

It was reported that additional capacity around epilepsy surgery was subject to a procurement process, the outcome of which should be known in February 2012.  The aim of the procurement was to:

(i)  Deliver additional surgical capacity;

(ii)  Allow earlier access to surgery;

(iii)  Organise service arrangements for 1-5 year old children.

It was emphasised that while work was progressing, it should be noted that no final decisions had been made around the arrangements and configuration of networks.  As such, there would be an opportunity to influence decisions through commenting on the range of documentation soon to be published.

Commenting on the information presented to the Board, representatives from Leeds Teaching Hospitals NHS Trust highlighted the following points:

·  In terms of the procurement for additional epilepsy surgery – a consortia approach effectively representing the North East of the country (involving Leeds, Sheffield and Newcastle Hospitals Trusts) had failed to reach agreement and had not submitted a bid to Stage II of the process.  However, it was re-emphasised that the procurement process aimed to secure additional epilepsy surgery capacity.

·  The potential implications for the sustainability of services associated with a  range of current designations around children’s services and the collective impact of individual reviews.

·  The review of Children’s Neurosurgical Services would impact on Children’s Neurosciences Services as a whole.

·  The history of the review has been professionally driven following a perception that the number of surgical centres in England was excessive and the care provided in a number of centres (i.e. not 24/7 cover) was not appropriate for modern services.  It was also suggested that the number of centres did not generate the number of cases necessary to maintain the level of surgical skills required.

·  There was some evidence that outcomes were not as good as they could be and there was some tension between the provision of emergency and elective (planned) services.  The proposed network approach, which was likely to see current surgical centres remain open (for at least 2/3 years), was seen as a compromise and was not whole-heartedly supported by all professional bodies involved.

·  An interview process, aimed at recruiting a 4^th neurosurgeon, was scheduled to take place in February 2012.

Representatives from Embrace and YAS provided the following comments:

·  Data collection over a 9-month period showed there had been around 170 transfers of children across the Yorkshire and Humber region; with many of these being low dependency repatriation transfers following surgery.

·  It was not anticipated that many children would need to travel long distances as a result of the review. 

·  A by-pass service for children suffering head injuries (utilising the air ambulance) was already in place.

The information outlined in the report and supporting documents presented to the Board were given full consideration, alongside the details highlighted at the meeting.

RESOLVED –

(a)  That the information presented be noted and the representatives in attendance be thanked for their contribution to the discussion;

(b)  That consideration be given to commenting on the range of documentation due to be published in the near future.

Cllr. S Armitage left the meeting during the discussion of this item at 12:15pm (approx.).

Cllr. K Groves and P Truswell left the meeting during the discussion of this item at 12:20pm (approx.).