Special report: A closer look at what radical healthcare plans mean for Grantham

Andrew Morgan, Chief Executive of Lincolnshire Community Health Service, gives a presentation following the publication of the Lincolnshire Sustainability and Transformation Plan.
Andrew Morgan, Chief Executive of Lincolnshire Community Health Service, gives a presentation following the publication of the Lincolnshire Sustainability and Transformation Plan.
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This week, proposals outlining the future of healthcare for the next five years in Lincolnshire were revealed. Among them is the potential downgrading of Grantham A&E, reports chief reporter Graham Newton.

Proposals published this week which could see Grantham A&E downgraded to an urgent care centre have received fierce opposition from campaigners and councillors.

Campaigners Melissa Darcey (F4GH) and Charmaine Morgan (SOS Grantham Hospital)

Campaigners Melissa Darcey (F4GH) and Charmaine Morgan (SOS Grantham Hospital)

The Lincolnshire Sustainability and Transformation Plan (STP) was released by Lincolnshire Health and Care (LHAC) after it was leaked to the media on Monday – a week ahead of schedule.

The proposals aim to save £130 million by 2021. The plan to downgrade A&E at Grantham comes as no surprise as it has been mooted for several years, but its inclusion in the STP this week has put campaigners on the warpath.

Melissa Darcey, of Fighting 4 Grantham Hospital, said the campaign would be stepped up and another protest march through town will be arranged.

She added: “The STP has confirmed a lot of what we, as a campaign, have been trying to get out there in the public domain. We are angry because it has proven that a lot of misinformation has been given. We are going to be ripping this STP to shreds.

Arthur and Jackie Whatley in one of the consulting rooms at the Emerald Suite in Grantham Hospital. EMN-160613-161005001

Arthur and Jackie Whatley in one of the consulting rooms at the Emerald Suite in Grantham Hospital. EMN-160613-161005001

“We are definitely not going to go quietly.

“If Grantham goes from an A&E to an urgent care centre then the whole of the southern quadrant of Lincolnshire will be left without an A&E. That is disgraceful.”

The proposals also include the reduction of the equivalent of 750 full-time healthcare posts across the county by 2021.

LHAC insists that the vast majority of those posts will go through ‘normal turnover’, such as retirement or relocation, keeping redundancies to a minimum. At the same time it is hoped to recruit more GPs to the county as the STP aims to increase care in the community and at home so that pressure is taken off our hospitals where delays in treatment have hit the headlines.

Grantham county and district councillor Ray Wootten said he feared lives were being put at risk as patients were forced to travel to Lincoln while the A&E is shut overnight, and that this would be made worse if it was closed altogether.

He said: “At Tuesday’s ULHT board meeting, medical director Suneil Kapadia stated that on Monday there were 80 patients waiting to be seen in Lincoln A&E, most waiting over five hours to be seen.”

He added: “I welcome the publication of future plans for healthcare in Lincolnshire, but find proposals to downgrade A&E at Grantham Hospital and turn it into an urgent care centre completely unacceptable. With the trust’s waiting times as low as 60% and averaging 78.4% I believe that Lincoln County Hospital will fail this winter with patients’ lives being put at risk having to travel from Grantham to Lincoln for treatment.”

Coun Charmaine Morgan, SOS Grantham Hospital chairman, said: “The news ULHT is proposing the downgrade of Grantham A&E to an urgent care centre is not surprising given their earlier comments, but quite appalling, given the impact on our community. It will put more lives at risk if it goes ahead. The STPs are forcing a one size fits all structure that does not work in rural areas. There are clear warning signs that the care in the community services are already overstretched.”

Speaking to the Journal after the publication of the STP, Gary James, chief officer of the Lincolnshire East Clinical Commissioning Group, apologised for the upset caused by the overnight closure of Grantham A&E.

Mr James said: “We want to see an end to this emergency measure at Grantham A&E so that the department should go back to the way it was. It’s really regrettable that this emergency measure has upset so many people around Grantham and I apologise for that and I think it will make the consultation harder now with them, so we want to consult with the people of Grantham to see what kind of service works there. I think it is highly likely it needs to be a 24-hour service of some kind.”

Mr James said he understood why many people felt that an urgent care centre at Grantham was a done deal. But he added: “It is regrettable that we have had to take this emergency measure because that will reduce the trust that people have in us as NHS leaders.”

Bosses say the plans aim to achieve:

* More investment in primary care and community services;

* Joined up health and social care service;

* Improved service effectiveness and the possible options to centralise some services ‘where it will deliver a better outcome for patients’.

STP lead Allan Kitt called the plans an ‘exciting opportunity for Lincolnshire’. He said: “For the first time we have a single plan to help us do this and we’re already making progress in a number of areas.

“The people of Lincolnshire deserve good quality care; we have a great opportunity now to overhaul the way our outdated services operate and provide care that is seamless and effective, where every pound spent delivers real benefit to our patients.”

The document includes a series of options across urgent care, women and children, including:

* New urgent care centres at the front of A&E at Lincoln and Boston;

* Urgent care centre to replace A&E at Grantham;

* Relocation of critical care to Lincoln;

* Relocating vascular surgery from Boston to Lincoln;

* Consolidating ‘hyper acute’ stroke services to Lincoln with a centralised ‘ Lincolnshire Stroke Unit’ and a single stroke team across Boston and Lincoln;

* Centralising all emergency paediatrics in Lincoln for mothers with complications;

* Developing a paediatric assessment unit at Boston;

* Having a single neonatal team across Lincoln and Boston with all neonatal services centred on Lincoln;

* Having a single maternity team across Boston and Lincoln, with a consultant-led obstetrics service in Lincoln with midwifery-led units on both sites. This also has alternatives including centralising consultant-led obstetrics and maternity units at Lincoln or developing a standalone maternity unit in Boston and relocating obstetrics services to Lincoln.

* The learning disabilities inpatient service in Lincoln could also be replaced with a community-based model.

The LHAC team said no decision has been made and any changes will be subject to a full public consultation, which is planned to take place in May next year after any local elections.

It is estimated hospital services in Lincolnshire will overspend by £182 million by 2021 if no changes are made to how services are delivered. LHAC says the £130 million savings, supported by an assumed additional £52m in national transformation funding, will bring the NHS in Lincolnshire back into balance within the five-year timeframe.

LINCOLNSHIRE BREAST CENTRE

A more positive aspect of the STP is a proposal to create a Lincolnshire Breast Centre in Grantham, a centralised unit where people from all over the county can be diagnosed and receive treatment for breast cancer.

Described as The Lincolnshire Breast Centre in the document, the centre would take care of all aspects of breast cancer care including screenings and surgery.

Such a centre has been mooted for several years following the opening of The Emerald Suite at Grantham Hospital in 2014.

But just a few weeks after its launch, the unit was reduced to being used at just a fraction of its capability because the health trust has been unable to recruit a radiologist.

The people of Grantham raised thousands of pounds for the Emerald Suite with fund-raising being coordinated by local couple Jackie and Arthur Whatley.

Mr Whatley gave a cautious welcome to the proposed breast centre at Grantham.

He said: “It’s brilliant for Grantham if they are bringing this facility here, but if they take the A&E away then that takes the edge off it.”

He added: “We have raised money for it and given it to the Grantham Breast Cancer Support Group and that is in trust. We have said it will not be released until we know exactly what’s happening. It’s very difficult to raise money for the suite when it is not fully open. The people of Grantham have raised this money for the suite and it’s for them.”

MORE CARE OUT OF HOSPITAL

One of the main aims of the STP is to provide more care in the community and at home so that frees up more beds in hospitals and relieves the pressure on them.

Allan Kitt, chief officer of the South West Lincolnshire CCG and lead for the STP, said: “The big shift will be in providing fully integrated health and care services in the community that support people much earlier on, before they reach crisis point and need to go to hospital.”

The STP also includes ambitious proposals for access to GP services seven days a week. The STP calls for GP practices to work together in larger groups to provide access to a range of services which will be provided by pharmacists, physiotherapists, doctors and nurses.

The STP says: “This will mean that patients will be able to get an appointment more easily and more services currently provided in a hospital setting will be available locally.

“We are working with groups and organisations in Lincolnshire’s communities to get people out of hospital as soon as possible.

“NHS bodies and local councils will work closely together to meet the demand for care home places and home support in a timely manner.”

Lincolnshire Health and Care (LHAC) says it is recruiting more GPs to become part of the new way of working.

A&E DOWNGRADE ‘NOT ACCEPTABLE’ SAY LOCAL AUTHORITY LEADERS

The leader of Lincolnshire County Council, Coun Martin Hill, says the potential downgrading of Grantham A&E department cannot be supported.

He said a county the size of Lincolnshire needs 24-hour emergency cover at all three main hospitals.

Coun Hill said: “Living in a large rural county, Lincolnshire residents have a right to expect three 24-hour hospitals operating in the county delivering appropriate emergency access and services.

“We do not support the permanent downgrading of Grantham hospital and do not believe that the maternity proposals at Boston would be safe for unforeseen emergencies in the eastern part of the county.

“The key question of achieving adequate staff recruitment and retention still remains unresolved and brings into

question whether the current NHS configuration in Lincolnshire is itself sustainable in the long term.”

Leader of South Kesteven District Council Coun Bob Adams said: “I am very disappointed. Grantham deserves better and we will continue to fight our corner to preserve full services at Grantham Hospital.”

* The full STP document can be found here.