Agenda item

To note a petition presented to Gloucestershire County Council on 28 November 2018 relating to concerns about X-Ray services at the North Cotswolds Hospital, Moreton-in-Marsh.

The committee to receive an update on changes to the provision of radiographic services in the county.

Briefing Paper circulated 10 January 2019

The committee was asked to note a petition presented at the Gloucestershire County Council meeting on 28 November 2018 expressing concerns about the future of X-Ray services at the North Cotswolds Hospital in Moreton-in-Marsh.

It was explained that the petition relayed ‘grave concerns that the NHS acute trust would be reducing radiology services from around 30 hours to 8 hours per week. This could have significant repercussions for minor injuries involving breaks and fractures, which would require making travel arrangements to Cheltenham or Gloucester should the service be reduced. The petition sought to ‘maintain the current level of local X-Ray services and ensure that the North Cotswold Hospital continued to serve the residents of Moreton-in-Marsh and surrounding villages’.

Members were informed that, prior to presentation of the petition at the Gloucestershire County Council meeting, Cotswold District Councillor for Moreton West, Cllr Alison Coggins, and members of Moreton-in Marsh Town Council met with NHS officials on Monday 12 November 2018 to discuss the provision of X-Ray Services at the North Cotswolds Hospital.

Chairman, Cllr Carole Allaway Martin, reported that the petition, (presented to the County Council in November with a little over 5k signatures), had increased in recent weeks, totalling 7k signatures at the beginning of the January 2019, now totalling nearly 9k. She clarified that a large proportion of the signatories signing the petition since November 2018, lived out of County. She explained that, in essence, petitions should reflect issues impacting on members of the community who lived or worked in Gloucestershire. For this petition, however, it was accepted that the context of the issue reflected general concerns, both nationally and locally.

Members attention was drawn to section 7 (implementation update section) of a briefing paper considered at the Health and Care Overview and Scrutiny Committee (HCOSC) meeting on 13 November 2018, advising of the intention (by the Gloucestershire Hospitals NHS Foundation Trust) to introduce temporary changes to the provision of radiographic services across Gloucestershire.

At the committee meeting in November, members were informed that the key driver for the changes was the ‘unsustainable level of staff vacancies and the risk of jeopardising safe provision of specialist interventional radiology services provided at the 2 acute and 7 community hospitals in Gloucestershire’. Proposed changes to the service were developed on the basis of patient safety, patient experience and workforce impact, with an anticipated reduction in service hours across the County’s 7 community hospitals from 252 hours to 177 hours per week (30%).

Members had been informed that, whilst radiographic services in Gloucestershire were regarded as ‘high quality’, recruitment for the service was unable to keep pace with the levels of staff turnover, resulting in an unsustainable position whereby the Gloucestershire Hospital NHS Foundation Trust was unable to provide the full range of radiology services; nor maintain the safety of patients.

Noting that the shortage of radiographic staff reflected the current national position, it was reported that the situation in Gloucestershire was significantly more acute than elsewhere in the South West Region, with a vacancy rate of 24% (compared to the regional average of 17%).

Conscious of the impact the changes might bring to patients with limited access to transport, arrangements had been put in place to provide transport services at each of the affected sites. Furthermore, additional capacity from service redesign initiatives endeavoured to prevent no overall loss of service capacity across the nine hospitals and avoid an increase in waiting times. The planned changes had been introduced on 19 November 2018.

The committee was informed that, whilst the revision of X-ray services across the county was regrettable, the need to make changes had been unavoidable in order to ensure the diagnostic services provided by Gloucestershire Hospitals Foundation NHS Trust operated safely. Despite a proactive and vigorous approach to recruitment, the appointment of suitably qualified staff continued to be challenging issue.

During the ensuing discussion, members questioned the temporary status of the changes and asked whether the changes might become permanent. They were informed that, as a temporary issue, the changes would be administered as a temporary measure. The changes would be monitored and reviewed in response to safety concerns, and every effort would be made to improve staff turnover and recruit experienced radiographers. At the same time, efforts would be made to retain key staff already in post. The aim was to restore services to the community as quickly as possible.

Requesting an indication of the timescales involved, members were advised that an initial 6 months was anticipated, culminating in a review of the position. In the meantime, regular feedback would be provided.

Acknowledging that the current shortage of experienced radiographers could continue in the long-term, members were advised that this would be addressed with investment in overseas recruitment and discussions with universities and other further education providers.

Bob Lloyd Smith from Gloucestershire Healthwatch confirmed that ongoing discussions were being held to consider the impact of the changes. He suggested to the committee that, whilst ‘no one wanted to see a reduction in services’,  as a management issue, the matter would need to be addressed and monitored ‘for as long as was necessary’.

Deborah Lee (Chief Executive of Gloucestershire Hospitals NHS Foundation Trust) acknowledged the petition and noted the committee’s concerns.

Deborah assured members every effort would be made to address the ‘impact of change’ affecting the delivery of services. She advised that new staff rotas have been introduced to support the necessary changes and Interventional Radiography (IR) services (operating 24 hours a day/7 days a week) had been put in place at Cheltenham General (CGH) and Gloucestershire Royal (GRH) Hospitals.

The Trust continued to work with partners to minimise the impact of the changes. Measures had been undertaken to maintain consistent opening hours to support the public’s understanding of what services were available and by the scheduling of X-ray provision on days needed to support outpatient clinics.

During the discussion, Members questioned the definition of the term ‘temporary’ and how long this was likely to be.  

Paying tribute to the work of the recently deceased colleague and friend, Gloucestershire County Councillor, Jack Williams, Cllr Harris proposed investment in smaller facilities and the lobbying of local MP’s as options to resuming normal service delivery. Cllr Harris also expressed concern about the anticipated timescale of the changes and informed members he had little confidence in the changes not becoming permanent .

Commending the petitioners, Cllr Harris requested that the ‘Health and Care Overview and Scrutiny Committee seek a written commitment from the Clinical Commissioning Group and Gloucestershire Care Services NHS Trust to restore the radiology service at North Cotswold Hospital in Moreton-in-Marsh and put together a plan to ensure a long term future for radiology at this site’. Cllr Nigel Robbins seconded the request. Several other members supporting the proposal.

Seeking views on the proposal, Cllr Allaway Martin endorsed that, (with the majority agreement of the committee), the committee write to the Clinical Commissioning Group and Gloucestershire Care Services NHS Trust, requesting restoration of the radiology service at North Cotswold Hospital in Moreton-in-Marsh.

It was also agreed the committee would add a review of the data available from which to monitor the changes and the management of expectations to the committee work plan.