The Westmorland and Furness Health and Adults Scrutiny Committee met to discuss a proposal by the Lancashire and South Cumbria Integrated Care Board (ICB) and the University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) to permanently cease Level 3 critical care services at Furness General Hospital. The committee agreed to recommend that the Trust and ICB treat the change as a substantial variation under 2013 Regulations, requiring full public consultation, and that the committee be briefed on the outcome of the engagement/consultation prior to a final decision being made by the ICB.

Furness General Hospital Level 3 Critical Care Services

The committee reviewed the proposal to make permanent the temporary arrangement to cease Level 3 ICU care at Furness General Hospital (FGH). Dr Andy Knox, Medical director for Lancashire and South Cumbria ICB, explained that the proposal was not a closure of the FGH ICU, but a change in how it operates. He stated that a Level 3 critical care service could not be safely ran and staffed at Furness General, and even with a fully staffed rota, they did not have the number of patients requiring Level 3 care.

Dr Knox referenced an independent review undertaken by the North West Clinical Senate, which recommended a treat and transfer model, where patients would be stabilised at Level 3 in FGH and then transferred for ongoing treatment to the Royal Lancaster Infirmary.

Councillor Waite raised concerns about health inequalities in Barrow, referencing a 14-year difference in life expectancy compared to people living in the Lake District. He expressed concern that ceasing Level 3 ICU services would worsen this inequality and requested a full consultation be undertaken. Craig Harris, Chief Commissioner of Lancashire & South Cumbria ICB, responded that the proposal was not about chipping away at services at FGH, and that people would continue to access services under the stabilisation and transfer model.

Scott McLean, Chief Operating Officer and Deputy Chief Executive UHMBT, stated that FGH was one of the best hospitals in England for not holding ambulances, and he was confident that the transfers, which occurred less than once a week, would not significantly impact the ambulance service. Dr Rachel Markham, Intensive care and clinical lead at UHMBT, added that transfers were common, with 35,000 critical care transfers annually in the UK.

Councillor Hanley asked about the lack of ICU consultants, suggesting it was a national problem and asked if the government should put more resources into increasing the number of doctors. Dr Markham agreed that there were not enough trained ICU doctors and that smaller units were struggling to recruit.

Councillor Hodgson read out a letter from a resident expressing distress about transfers and asked about capacity at Lancaster. UHMBT representatives responded that since the interim model had been in place, patients had been accommodated with no problem, and bed capacity was monitored daily.

The committee recommended that the Trust and ICB treat the change as a substantial variation under 2013 Regulations, requiring full public consultation, building on the proposed Communications and Engagement plan, and that the committee be briefed on the outcome of the engagement/consultation prior to a final decision being made by the ICB.

Documents provided to the committee

The committee were provided with a number of documents to support their discussions, including:

• A joint covering letter from UHMBT & ICB
• A submission from UHMBT & ICB in response to queries from the Committee
• The NW Clinical Senate Report
• A Lancashire and South Cumbria Critical Care Network presentation
• A Comms and Engagement Plan proposal
• Available research evidence including RCT and meta analysis re: high volumes
• GPICS v2.1 (intensive care guidance referred to in Clinical Senate report and in submission)
• FAQs
• Treat and Transfer SOP

The Public reports pack included a joint submission from UHMBT and the ICB outlining the proposal changes and answers to questions raised by the Committee. The report stated that the decision to recommend making the temporary suspension of ongoing Level 3 ICU care at Furness General Hospital permanent was made on the grounds of safety. The low number of patients seen and treated by the unit compromises the ability of the Trust to recruit and retain clinical colleagues to run the ICU to the required standard.

The report also addressed concerns about the nature of business at BAE Systems and how that leads to an increased need for a local ICU at Barrow. However, the North West Clinical Senate panel were in consensus agreement with the commissioners' conclusion that any such need would most likely arise from a major trauma incident, in which case patients would be taken to Preston or beyond; or from a nuclear incident, in which case critical care services at FGH would be unlikely to provide a viable operational response.

The Communications and Engagement Plan outlined how the ICB and Trust would inform, engage, and reassure the public, staff, and stakeholders in Barrow-in-Furness about the proposal. The plan included drop-in engagement sessions, community briefings, online engagement, and staff engagement sessions.

The North West Clinical Senate Review stated that the panel supported the commissioner and provider conclusions that a Level 3 ICU cannot be maintained in its current form at FGH and supported the case for permanent change to maintain only a Level 1 and 2 critical care service at FGH, subject to defining the new service model for stabilisation and transfer of patients with Level 3 needs.

The Lancashire & South Cumbria Critical Care Network presentation stated that FGH has faced over a decade of challenges in sustaining an Intensive Care Consultant workforce and that the current model of stabilisation and transfer of Level 3 patients to Royal Lancaster Infirmary (RLI) is safe, effective, and sustainable.

The Updated combined HASC response included a correction to the data that had been presented to the committee.