1. Text here Healthwatch Cumbria Working Together to Plan the Future of Hospital Services in North and West Cumbria

2. Text here AGENDA 6.30pmWelcome, Introduction & housekeeping 6.40pmPresentation of Clinical Options Appraisal (NCUHT) 4 service areas for discussion 4 facilitated discussions (HWC) 8.15pmOther Challenges & Issues (HWC) 8.25pmNext Steps (HWC) 8.30pmClose

3. Text here Healthwatch Cumbria; Independent Consumer champion for health and social care Listens and records experiences and concerns of people Sends reports to commissioners and service providers Requires responses A powerful voice locally and nationally

4. Text here The process Engagement events - over 3 weeks West and North Cumbria Survey also widely available (closing date 19 Dec) Every view is valid Collate, analyse all contributions Themes, trends, ALL recorded comments Report - to the Trust in January

5. Text here Some ground rules Listen to, and respect each other Facilitators will record conversations Every opinion is valid Please stay focused on each topic Keep to time

6. Working together to plan the future of hospital services Public engagement – Winter 2014

7. Engagement activity We want to give you the opportunity to understand the challenges we face and our early suggestions on how to solve them We want to make sure we take account of your views in our ideas We have asked Healthwatch, as an independent organisation, to lead this public engagement process for us and they will provide the Trust with a report in January which we will share publicly Please note this is NOT a formal public consultation. Once we have taken all views into account, the commissioners of NHS services in Cumbria, NHS Cumbria Clinical Commissioning Group (CCG), will then decide what they think are the best options for the future of our hospitals. If the final options represent a substantial change to services, these will be the focus of formal public consultation with local communities led by NHS Cumbria CCG

8. A reminder of who we are Two district general hospitals Midwifery-led services at Penrith Birth Centre Serve a population of 340,000 Over 4,000 staff

9. Improvements to date Big improvements in the past 18 months Mortality rates are now within expected range after being amongst the highest in England More people are surviving serious injury or illness All of our services and departments were rated good for providing a caring service to patients “Throughout our inspection we witnessed patients being treated with compassion, dignity and respect” Chief Inspector of Hospitals – July 2014

10. However…. We remain in special measures as we have some big challenges that we need to solve. These are linked to: – Our two hospitals being located very far apart in rural areas – We treat low numbers of patients in comparison to other hospitals – This makes it hard to attract permanent staff who choose to work elsewhere – This means that we are not meeting all clinical rules about the high standards and quality of care that patients have a right to expect and receive We want to change this so that our hospitals can be the best in the NHS in the future and our patients get the best possible care 24/7

11. We greatly value your views These are problems that we cannot ignore if we want to get better We are sharing our thinking so far and we are very interested in hearing your views about: – The challenges we face – The potential options we feel are available to solve them

12. What is acute medicine? Acute care is how we look after the most seriously ill people in an emergency after they arrive at A&E Both of our hospital have: – 24/7 A&E departments – emergency medical admissions – intensive care units Every year we have 75,000 A&E attendances and around 30,000 emergency admissions to hospital In the future this WILL continue but the place where we initially treat a very small number of seriously ill patients may change

13. Addressing the challenges in acute care Why is change needed?What would we like to do?  To improve results for patients and potentially save more lives  Because the acute medicine service at West Cumberland Hospital is not safe enough due to staffing problems  It was rated as ‘inadequate’ because we do not have enough doctors who are permanently employed  We are spending over £1million each month on temporary staff which we can’t afford to keep doing  We want to attract more permanent doctors to West Cumberland Hospital, which will be better for patients and cost us less  To do this we would like to move a small number of the most seriously ill patients from West Cumberland Hospital to Cumberland Infirmary by ambulance - where specialist support, would be available 24 hours a day, seven days a week, for the first phase of their treatment

14. Now over to Healthwatch for discussion 1

15. What is the challenge with obstetrics and midwifery? We have a low number of births in our two consultant-led units. In 2013: 1686 births at Cumberland Infirmary 1313 births at West Cumberland Hospital There are very few consultant-led units in the country with less than 2000 births This presents us with challenges which we need to talk about

16. Addressing the challenges in obstetrics and midwifery Why is change needed?What have we been discussing?  The low number of births in our hospitals, coupled with ongoing difficulties in recruiting the right number of permanent medical staff – in particular anaesthetists, is concerning  The Chief Inspector of Hospitals told us ‘the maternity service at West Cumberland Hospital was not sufficiently safe’ because of the lack of anaesthetists available to respond to women in labour in an emergency  At the moment West Cumberland Hospital only has one anaesthetist available at any one time to respond to both medical emergencies as well as maternity emergencies – this is not acceptable for the future We have been thinking about how we might be able to solve this problem and our potential ideas so far include: 1. Continue with two consultant-led units and two special care baby units and also provide co- located midwifery-led units with extra staff on each site to increase choice for women 2. Provide one consultant-led unit and one special care baby unit with a co-located midwifery-led unit at Cumberland Infirmary and a midwifery-led unit at West Cumberland Hospital 3. Provide one consultant-led unit and one special care baby unit with a co-located midwifery-led unit at Cumberland Infirmary and a midwifery-led unit in Allerdale

17. The future of maternity services is dependent on the outcome of the Cumbria–wide independent maternity review commissioned by NHS Cumbria CCG and led by the Royal College of Obstetricians and Gynaecologists This has now begun and is expected to report in 2015

18. Now over to Healthwatch for discussion 2

19. What is paediatric care? Paediatric care is how we look after children in hospital We provide assessment and inpatient services at both of our hospitals Every year we care for over 6,500 children who arrive via A&E and need assessment and treatment We also provide over 54000 outpatient appointments for children receiving planned care In the future this WILL continue but the place where we initially treat a very small number of seriously ill children may change

20. Addressing the challenges – paediatrics Why is change needed?What would we like to do?  If a child is very sick and needs to stay in hospital, they should be surrounded by experts around the clock and this does not happen consistently in our hospitals  We do not meet the current required clinical rules for medical and nurse staffing in children’s care. In particular the need for every child to be assessed within four hours of admission by a senior doctor  The Chief Inspector of Hospitals was concerned about night-time ‘paediatric’ cover in both of our hospitals and also how we sustain consultant cover in the long term We want to improve care for children who are seriously ill and require a stay in hospital. To achieve this we would like :  A 24 hour short stay children’s unit at West Cumberland Hospital with access to 24 hour local paediatrician cover. It would still have beds for children who have less serious injury or illness and need to stay in hospital… AND  A dedicated unit at the Cumberland Infirmary for sick children who need to stay in hospital for longer and need specialist paediatric care. Most children would still be cared for locally in Whitehaven and we think around one child per day might need to move to the Cumberland Infirmary

21. Now over to Healthwatch for discussion 3

22. What is planned care? Planned care is when patients are referred to us by their GP for treatment Every year we provide: Over 40,000 planned operations and day case procedures Over 100,000 diagnostics tests and investigations such as x-rays, scans, endoscopies Over 250,000 outpatient appointments In the future we want to see ALL of our patients being treated quickly and within national waiting time standards

23. Addressing the challenges – planned care Why is further change needed?What would we like to do?  We are still not meeting all of the national rules about how long patients should wait for their planned care  We are still having to cancel planned operations at short notice which is not acceptable  We know that there are patients whose local hospital is West Cumberland but who currently have to travel to Cumberland Infirmary in Carlisle, or further afield, for their planned care  Increase the total number of patients who receive their care locally  Increase access to specialist but low risk procedures at the West Cumberland Hospital  Increase the amount of planned day case and low risk surgery which takes place at West Cumberland Hospital  Provide timely access to planned care for all of our patients at the new West Cumberland Hospital

24. Now over to Healthwatch for discussion 4

25. Text here Other challenges and issues? We have a few minutes left for you to raise any other points not covered in the discussions so far

26. Discussion 5 Any other points?

27. Text here Next Steps Facilitate further event Keep recording all comments Collate and analyse themes Remember to complete survey Further comments to HWC Report to Trust in January Leave your email Thank you

28. Text here How to contact Healthwatch TEL: 03003 038 567 info@healthwatchcumbria.co.uk www.healthwatchcumbria.co.uk