Monday 4th September

South Tyneside and Sunderland Joint Health Scrutiny Committee

As you may know Sunderland NHS Foundation Trust and South Tyneside NHS Foundation Trust have formed an 'alliance' (which might be better called a merger since there is now only one chief executive for both trusts - Ken Bremner). Our borough councils are responsible for overview and scrutiny of 'substantial reconfiguration proposals'. As the 'path to excellence' proposals affect both boroughs, South Tyneside and Sunderland councils are required by law to form a joint committee to carry out their duty to scrutinise these proposals. The Joint Scrutiny Committee is comprised of elected councillors who have been selected to the committee by the council.

This joint committee recently held a meeting in conjunction with health authority leaders including: David Gallagher (Sunderland CCG Chief Executive), David Hambleton (South Tyneside CCG Cheif Executive) and Ken Bremner (The Cheif Executive of both Sunderland and South Tyneside Hospital Trusts). The purpose of the meeting was to invite representatives of hospital staff and our local communities to give their comments, evidence and questions. You can find more information and a full list of the participants in the agenda (PDF).

Joint Health Scrutiny Meetings are open to the public (although the public is not permitted to speak). It was a long meeting lasting over 3-hours. The following are some of the comments presented at the meeting:

Clare Williams - UNISON Northern Regional Secretary

"We [UNISON] understand the wider political context in which our public services are currently operating. We understand that central government is forcing health trusts and other public services to make cuts year on year, and then [they] use the euphemism of financial pressures when they're actually talking about cuts to budgets."
"From our perspective it is essential not only to engage now, but actually actively involve all of the staff who are delivering those services. My view is that the staff delivering the services know first hand where the problems are and where improvements can be made."
"There is a lack of detail around future workforce or staffing models, what the future workforce requirements need to be, how will they be addressed, how will people be trained, how are vacancies that are currently in the system going to be addressed, and what does that mean in terms of delivering any type of new clinical service model going forwards?"
"Without a doubt we have to raise significant concerns about the level of risk. ...If particular services move from South Tyneside, particularly urgent and emergency services and maternity services to Sunderland, what is the capacity of the North East Ambulance Service (NEAS) to respond in a timely way. ...I think there remain considerable risks in the system regarding the capacity and ability currently of the ambulance service to be able to respond to additional increased demand at this time."

"...That leads on to concerns generally around the public transport infrastructure. I [looked] through the Travel and Transport Review and I have to say that some of the assumptions that are made in there [appear] theoretical. ...In reality we all know that our infrastructure is not that good. ...I think that if you do an assessment of public transport from parts of South Tyneside to Sunderland, some of those time frames [presented in the aforementioned review] would be significantly different.

...From a UNISON perspective, there has to be accessible services that are sustainable for the people of South Tyneside"
"[with regards to Sunderland] There is a complete lack of detail about what the impact would be of any services moving to Sunderland in the sense that there will be an increase in demand for Sunderland's services, but where is the capacity in the system to meet that demand? What are the implications for Sunderland around waiting times and accessibility of services, and also accessibility around the [hospital] site in Sunderland."
"No body would dispute that we want to have much better health outcomes in the North East, but the devil really is in the detail, and there is not enough money [being made] centrally available to meet those aspirations. ...People do need certain services, particularly emergency services that are accessible to where they live. That's got to be a fundamental underpinning principle."

Emma Lewell-Buck MP (South Shields)

"The Tory government have made it very clear that the STP process will be cuts driven. It will effect 44 areas in England including ...our own. These areas have been mandated by the government to come up with cuts, and that's why we are where we are today."
"At present we continue to have grave concerns that the current proposals that are out for consultation are not in the best interests of the people of South Shields, let alone South Tyneside as a whole. ...I have repeatedly expressed my view that the consultation process itself has not been as transparent as the CCG would have us believe, and I am yet to be persuaded that the options being presented have been developed with the full involvement of the relevant clinicians. Evidence shows that [some clinicians] have actively been blocked from taking part in the formulation of proposals for their own departments."
"Like others I have also noted that the journey times stated in the proposal documents are yet to be tested in real time."
"I find it outstanding that we have a proposal document ...yet nobody is able to say the implications for jobs and job cuts. If you formulate a proposal, you should have had that [data] in the consultation document, and said that there is possible loss of staff"
"You'll be aware that I have written to the Joint Committee twice, requesting that the consultation and the proposals be referred to the Secretary of State for Health. The request has been refused on both occasions, but is well within the scope of this committee. I would like to reiterate that matters can be referred mid-consultation."
"Finally ...this remains a huge concern of mine and my constituents, that the leader of the council is a paid director of the hospital. He chairs the 'Health and Well Being Board' that holds the CCG (that are driving these proposals) to account. If this committee wants to improve public trust and perception around transparency and the democratic process, it would have been advisable at some point to put on record a comment around the leader of the council..."
"[The consultation] is predicated on the fact that the CCG are saying that it's been done in consultation with consultants. When I have a wealth of information from consultants that say that is not correct."

Sharon Hodgson MP (Washington and Sunderland West)

"We cannot escape the fact that these plans are about cuts. Cuts which are passed off as efficiencies but nevertheless are being inflicted upon our NHS from a national position which is ideologically driven."

"Though, from recent information released to the public, there have only been 414 survey responses to date. Is that correct? It may be a little higher since that figure was released. Now I don't have the population figure to hand that this consultation covers but it's many hundreds of thousands ...So that does seem a little low to me?

So I have genuine concerns that these responses will not fully reflect the thoughts of local people, and as a crucial way for people to engage with this consultation, I hope that the two remaining sessions planned will be opened up to as many people as possible to allow people with as many opportunities as possible to engage with the future of local provision.

Decisions as great as these should have the fullest engagement from local people so that services reflect what they wish and expect.

It is also important that groups who are harder to engage with, through many complex reasons, have their say including young people and older people, disabled people, BME communities and LGBT people.

Some of these groups access services on a regular basis and it is crucial that they are listened to, just as all of us should be."
"These plans will change the very nature of our local NHS services."

Julie Elliot MP (Sunderland Central)

"I endorse entirely what has been said by my colleges with regards to the STP and cost cutting measures. That is very much what has been said in parliament."
"Many of my constituents use South Tyneside Hospital as much as Sunderland because it's quicker to get there, as there are bridges involved in getting to the other side of Sunderland. ...[Even from my community], some of the bus services into Sunderland (never mind from South Shields) stop at 6pm. ...At the moment, the 'E' services (which are the main services between South Tyneside and Sunderland) are stopping in John Street and not going all the way up to the Park Lane interchange where most of the services to Sunderland Royal go from. That's already causing a problem for residents in Sunderland, never mind coming up from South Tyneside."
"As far as the consultation is concerned, I do find it a bit strange that some of these things are happening and have happened, particularly with stroke. I do find it frustrating consulting upon things that are already in process."
"There are ~450,000 people who live in the two boroughs. A few hundred or a thousand people [consulted] is not a lot of people. ...I spoke to 6500 people in the general election campaign, and most people are totally unaware that this is happening."
"It's not just the initial treatment that is crucial, it's the after-care and the rehabilitation. If people are needing, once they have been discharged, to be attending hospital on a daily basis, that needs to be done as near to where the person lives as possible. For people who have mobility problems (often the result of stroke) it is difficult for them to get somewhere."
"I think there is a need for both maternity units to still exist. I am very concerned at some of the timings being mentioned between South Shields Hospital and Sunderland Royal. If a labour goes into difficulty any medical professional will tell you that you have 5 or 6 minutes to intervene, and even by helicopter you can't get from South Shields Hospital to Sunderland Hospital or [visa-versa] in 5 or 6 minutes. ...Even if we move to a model where the consultant led unit is at Sunderland and a midwife led unit at South Tyneside, and planned high-risk pregnancies are being dealt with where the consultants are, things happen when your giving birth, that's the nature of giving birth."
"...Some 17 thousand attendances [to the Children's A&E] at South [Tyneside Hospital in one year]. Is there any information on the 12 hours that are being proposed [in which Children's A&E will only be open during the day]. ...What numbers of people actually use the hospital during those 12 hours, and what numbers use it outside of those 12 hours?"
"I want to talk about capacity. Part of my constituents use South Shields as much as Sunderland. My concern with the Sunderland site is the capacity. The number of beds has reduced in recent years. It's gone down by 80 from 2012 to 2017. It's always at [full capacity]. Every department always seems understaffed, not necessarily on paper, but in real terms."
"Parking at the hospital probably represents 10 percent of my case load. Very sadly in recent times, the parking system in place at the City of Sunderland Hospital has been introduced at the South Tyneside site. It is only my personal view, but it possibly the worst system of Hospital Parking that I have experienced anywhere."

Stephen Hepburn MP (Jarrow)

"Alliance to me suggests parity and fairness. But all I have seen so far is a transfer of services from South Tyneside over to Sunderland. ...As far as calling it the 'Path to Excellence' it should be called the 'Road to Inferiority'. How can you say it is a 'pathway to excellence' when services are being downgraded?"
"The Maternity in South Tyneside, from the reports I've read, is a service bar-non in the region. ...Over 2000 children are born in South Shields Hospital every year. ...How many of those will be born in Sunderland? How is Sunderland going to cope? ...I've had meetings with clinicians who are terrified to say anything."
"The consultation document for [the 'Path to Excellence'] proposals is being freely distributed around the hospital. Yet when we tried to put out a leaflet saying that we were going to have a meeting to discuss with concerned staff the issues they want to raise with us, they're stopped from putting them around the hospital. So what sort of open and transparent way is that to run a consultation."

The Joint Health Scrutiny Committee are certainly aware of the problems with moving vital services out of South Tyneside to Sunderland:

Councillor Robert Dix

"I had to go to Sunderland Hospital last year. It took me 50 minutes in the car, and that was at 2pm in the afternoon. ...It's quite a hike even in a car, and your not stopping to pick passengers up every five minutes [like a bus]."

Councillor William Brady

"Just last year I had occasion to go to Sunderland Royal. ...I had to be there at quarter past eight to sign in. ...I asked is there a bus? is there a train? I had to get a taxi. I'm lucky, I paid for the taxi, my grandson picked me up and brought me home. But there are people who no way could they afford a taxi to get to Sunderland or back to South Shields. Where I live it takes 3 buses to get to Sunderland. I did ask the transport people if there was an alternative, and they said there is a direct service from Boldon ASDA. That means I had to get on a bus from where I live to Boldon. I got on that bus with great expectations because they said it was a direct bus and it was quicker. It took one hour and ten minutes from Boldon to where I go off outside the Royal Hospital.

One of the things I'm asking about now is the cost. Not just whether there going to put the buses on, but how much is it going to cost people. ...If you've got to go to hospital outside of [bus timetable] hours, there is no way to get a bus."

Video of JHSC meeting covering the comments and questions quoted above.