The Chair introduced an item of urgent business, and explained that the matter appeared at her request and that of Councillor Julie McManus. The Chair informed that after many years as a councillor (most of that time involved with health and social care) this was the first time she had known this happen, and how the action by the Clinical Commissioning Group (CCG) had resulted in very significant public concern, with a petition signed by around 5000 people, all 4 Wirral M.P.s were asking questions and expressing concern, as were the local councillors and colleagues on the Scrutiny Committee for Cheshire West and Chester Council.

The Chair further informed that it was very important that decision makers were held to account for the decisions they make and that health providers had a statutory responsibility to submit plans that may significantly change the delivery of service to this committee for scrutiny in advance of the proposed change, and that not to do this should only happen in exceptional circumstances.

The Committee noted that this plan had not been submitted in advance, and that no request by Wirral CCG had been made to include it on a future agenda. Members also noted that the Chair and Cllr McManus were not convinced by the explanation given to them on Friday 1 September when they had been called to a meeting with the CCG and Wirral Community Trust to be told that the planned closure was to take place on Monday 4 September. The explanation having been given being that the urgency was the need to protect the safety of patients and staff. Councillors McLaughlin and McManus were also unconvinced that sufficient consideration had been given to the negative  impact the closure would have on people living in Eastham, particularly as the same day the closure took place, the only direct bus route from Eastham to Arrowe Park had been withdrawn.

The Chair expressed the concerns of the Overview and Scrutiny Committee that the recognised deficiencies in performance for the A&E service at Arrowe Park Hospital did not provide substantive grounds for the withdrawal of the Eastham Walk-In service, and begged the question as to why information had not been provided to Members on this matter and why earlier actions had not taken place by NHS management to address the issues at Arrowe Park.

The Chair called upon Mr Simon Banks, Chief Officer Wirral CCG to address the Committee on the reasoning behind the recent change to the services provided at Eastham Walk-In Centre.

Mr Banks informed the Committee that the urgency of this matter had arisen from the necessity of speed under the Trust’s duty of care under the Health and Social Care Act 2012, and that the decision had been taken in consultation with the Chief Executives of both the Wirral Community Trust and Arrowe Park Hospital. The decision had not been taken lightly and was scheduled for review at both Eastham and Arrowe Park on a week by week basis. He informed that there were no plans to close the Eastham Walk-In Centre and that all changes (permanent or temporary) required equality impact assessments to be undertaken. He further informed that the CCG and the Trust would also be held to account by NHS England.

Mr Banks explained that a number of factors had come into play, namely the higher than average referrals from Eastham to Arrowe Park, and how other Walk-In Centres on the Wirral were of a higher specification.

He explained that Eastham Walk-In Centre provided extended Primary Care facilities and was nurse-led, and that the transfer of the suitably qualified (A&E experienced) nurses served the public good more effectively by helping to reduce the number of elderly patients held on trolleys or in ambulances prior to A&E treatment at Arrowe Park. He added that the current situation there was ‘not a great place to be’. He added that NHS England and Social Services were all responding in the best practical ways to urgent need and demands on their services. He further added that the NHS was committed to long term solutions and the options appraisal undertaken had identified that the 3 people with the appropriate skills were best utilised at the Arrowe Park facility.

The Chair then invited Ms Karen Howell, Chief Executive Wirral Community Trust (Eastham Walk-In Centre) to address the Committee. Ms Howell informed Members that the change to services at Eastham had not come about without proper assessment, and explained that the Trust had looked at the activities at Eastham including comparison to other Walk-In Centres across Wirral. She explained that Eastham had no ‘back office’ facilities and was not commissioned for diagnostics, the main functions of the Centre related to advice to young mothers / young adults and the management of dressings for the elderly.

Ms Howell apprised Members of the Committee that the transfer of 3 staff was based on their qualifications and experience of A&E Triage, and had been deployed quickly on the grounds of safety. It had not been an easy ‘hit’. This had been the best decision in terms of urgency and safety.

Members provided Mr Banks and Ms Howell with a variety of statistical evidence on the number of service users and relayed the concerns of Cheshire West and Chester Councillors whose Wards abutted the Wirral boundary and whose electorate also used the Eastham Walk-In Centre. Members informed that they too were appalled that there had been no consultation on the service revision.

A variety of views were expressed by Members on the subject of A&E Triage, lobbying of Government and Access to Services utilising Public Transport. It was acknowledged that an ageing population and co-morbidity associated with this had placed additional pressures on the Health Service, but this was not a new phenomenon. 

In summing up, the Chair welcomed the comment from Mr Banks that this was to be a temporary measure and that there were plans to reinstate the service at Eastham Walk-In Centre at the earliest opportunity. She added that the Committee was keen to hear the response from MerseyTravel on the subject of the route cancellation, and was surprised that there had been no mention of better access to G.P. Services which also had an impact on the demand for Walk-In Services in Eastham. 

It was proposed by Councillor Moira McLaughlin, duly seconded, that:

“Committee thanks Simon Banks and Karen Howells from Wirral CCG for their attendance, at short notice, to explain the reason for the decision to close Eastham Walk-In Centre with one week’s notice and without referring it to this committee for scrutiny in advance of closure.

Committee notes the explanation that the statutory responsibility of health providers to report significant changes in service delivery was overridden, on this occasion because of their belief that the situation was so urgent that not to take this action would represent a serious risk to the staff and patients.

Committee also notes the information given of the directive from the Secretary of State for Health to introduce streaming in A&E Departments by mid-September.

However, we remain concerned that the pressures on A&E at Arrowe Park Hospital have been present, understood and reported for a considerable period of time, and that the reasons for this are complex.

We therefore believe that planning this change could and should have taken place at an earlier stage, so allowing for proper consultation to be carried out and also for the statutory duty to report the change to the committee to be fulfilled.

We also believe that, in taking this decision, insufficient consideration has been given to the difficulties this closure will present to those living in that part of the Borough, the reduced accessibility of Arrowe Park Hospital brought about by the recent withdrawal of the only direct bus service from Eastham to Arrowe Park Hospital, and the information given to members of this committee that the streaming system recommended by the People Overview and Scrutiny Committee report in its ‘Reducing Avoidable Admissions’ report which was implemented and then withdrawn in less than a year, was withdrawn, we were told, as it did not reduce the pressure on A&E as anticipated.

We therefore request that a further report which details the impact of the closure on Wirral residents, particularly those living in that part of the Borough, any change in the performance in A&E at Arrowe Park Hospital, and any savings which are realised as a result of this action be presented to the next meeting for further scrutiny.

We also request that Wirral Clinical Commissioning Group (CCG) re-consider this decision and calls upon the CCG to recognise that future plans to improve performance in A&E are developed in such a way that other vital parts of the health service are protected for residents in all parts of Wirral.”

An amendment was proposed by Councillor Phil Gilchrist, seconded by Councillor Chris Meaden, to include the addition of the following final paragraph:

“This Scrutiny Committee calls upon the CCG to recognise this as a formal request for early reinstatement of the service and respond quickly to the concerns raised.”

Resolved (unanimously) – That

Committee thanks Simon Banks and Karen Howells from Wirral CCG for their attendance, at short notice, to explain the reason for the decision to close Eastham Walk-In Centre with one week’s notice and without referring it to this committee for scrutiny in advance of closure.

Committee notes the explanation that the statutory responsibility of health providers to report significant changes in service delivery was overridden, on this occasion because of their belief that the situation was so urgent that not to take this action would represent a serious risk to the staff and patients.

Committee also notes the information given of the directive from the Secretary of State for Health to introduce streaming in A&E Departments by mid-September.

However, we remain concerned that the pressures on A&E at Arrowe Park Hospital have been present, understood and reported for a considerable period of time, and that the reasons for this are complex.

We therefore believe that planning this change could and should have taken place at an earlier stage, so allowing for proper consultation to be carried out and also for the statutory duty to report the change to the committee to be fulfilled.

We also believe that, in taking this decision, insufficient consideration has been given to the difficulties this closure will present to those living in that part of the Borough, the reduced accessibility of Arrowe Park Hospital brought about by the recent withdrawal of the only direct bus service from Eastham to Arrowe Park Hospital, and the information given to members of this committee that the streaming system recommended by the People Overview and Scrutiny Committee report in its ‘Reducing Avoidable Admissions’ report which was implemented and then withdrawn in less than a year, was withdrawn, we were told, as it did not reduce the pressure on A&E as anticipated.

We therefore request that a further report which details the impact of the closure on Wirral residents, particularly those living in that part of the Borough, any change in the performance in A&E at Arrowe Park Hospital, and any savings which are realised as a result of this action be presented to the next meeting for further scrutiny.

We also request that Wirral Clinical Commissioning Group (CCG) re-consider this decision and calls upon the CCG to recognise that future plans to improve performance in A&E are developed in such a way that other vital parts of the health service are protected for residents in all parts of Wirral.

This Scrutiny Committee calls upon the CCG to recognise this as a formal request for early reinstatement of the service and respond quickly to the concerns raised.