Members discussed NHS England’s proposals and UHL’s initial response and made the following comments/statements and asked questions (these have been grouped into general themes for ease of reference). NHS England’s response to the comments/statements and questions made during the meeting are shown below each themed area.
The Chair commented that other local authorities across the East Midlands were also extremely concerned about the proposals and were feeling upset and destabilised by these proposals. This issue was of concern across the whole of the region and not just to the Leicestershire, Leicester and Rutland area. A petition signed by people all across the region had also been sent to London.
ISSUES RELATING TO STANDARDS
a) There was concern about the process by which the standards were fixed and introduced which then resulted in losing a good service that was currently appreciated by everyone and the new system of standards would prevent it from being provided.
b) It was questioned whether all NHS Trusts currently providing Level 1 CHD services been given the same support by NHS England to reach the new standards and whether any NHS Trusts had been given more time to reach these standards than other NHS Trusts.
c) Members asked for the evidence base used by NHS England to determine that each surgeon should undertake 125 operations per year. Members referred to the quote from The School for Health and Related Research in Sheffield, which had stated that “whilst a relationship between volume and outcome exists this is unlikely to be a simple, independent and directly causal relationship, i.e that no cut-off relating to surgical volume and better outcomes was identified. There was never any indication of the number of minimum or maximum cases which should be done each year by an individual surgeon.” As such, the figure of 125 was arbitrary and it was questioned why a surgeon carrying out 100 operations a year could not be as good as one carrying out 150 operations per year.
John Adler clarified that UHL did not dispute the numbers in the standards per se but did dispute how they were being applied. In relation to Newcastle, there appeared to be no evidence to suggest they would ever reach those numbers in the standards but NHS England were prepared to allow them to continue providing Level 1 services because they also undertook transplant services. UHL felt that, if it was safe for Newcastle to continue providing Level 1 services with numbers considerably smaller than Leicester, then why was it not safe for Glenfield to continue to provide Level 1 services which would also allow them to continue to support the national ECMO service, which they had pioneered and developed.
NHS England responded by indicating that if Newcastle could not meet the numbers in the future in the agreed time frame then it would be necessary to revisit the issue of commissioning those services. It was further emphasised that there was no implication in NHS England’s proposals that any current service ... view the full minutes text for item 30