News from Cumbria Action for Health

The latest news from Jozi Brown, Senior Engagement Officer at Cumbria CVS

An opportunity to engage in the design of the Cumbria Health and Social Wellbeing System
13 April 2015
1 to 4pm
Rheged, Penrith
please note we’ve changed the venue to Rheged so we can accommodate more people.
Anyone who has already booked a place will have been informed already, and if you’ve already forwarded the invite on to colleagues – don’t worry as we’ll make sure anyone else who books to attend will get notified too.

Many of you will have heard Colin Cox (Director for Public Health here in Cumbria) speak about the future of public health, and plans to develop universal and targeted health and care prevention services. The vision is for the service to support people in Cumbria to live well, by addressing the factors that influence their health and wellbeing, and build their capacity to be independent, resilient and maintain good health for themselves and those around them.

This session is an opportunity for you to engage at the ‘design’ stage of this process and will be of particular interest to any of you that are involved in supporting and/or delivering ‘preventative services’ for frail and/or vulnerable people in Cumbria.

To book a place, please complete the attached booking form and return it to
We expect there will be lot of interest in this meeting so please get your bookings in as soon as possible, if you’ve not done so already.

As you’ll see ( ) a report is due to Cabinet by the 30 April 2015 hence the timescales for the engagement meeting. The Public Health Team at Cumbria County Council is planning to circulate a briefing document to give you a better idea of what is being covered at the meeting (and this will enable anyone who can’t get to the event to still give their feedback). As soon as we have it we’ll forward to you.

Share your experience about North Cumbria University Hospitals NHS Trust
(request from the Care Quality Commission)
England’s Chief Inspector of Hospitals is inviting members of the public to tell his inspection panel what they think of the services provided by North Cumbria University Hospitals NHS Trust. Their views and experiences will help inspectors decide what to look at when they inspect the services provided by the Trust in March this year.
The Trust was previously inspected in April 2014 and given an overall rating of ‘Requires Improvement’ under radical changes which have been introduced by the Care Quality Commission.
This follow up inspection of the Trust will start on 31 March 2015 and will focus on previous findings. The inspection team are particularly interested in hearing the local public’s experiences since the previous inspection but also to say where they would like to see improvements made in the future.

Anyone who wishes to give their views to the inspection team can do this by:
By letter: CQC, Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA
By phone: 03000 61 61 61

The Inspection Team will be speaking to patients when on site during the course of the inspection to get their views.
Sir Mike said “The new inspections are designed to provide people with a clear picture of the quality of the services in their local hospital, exposing poor or mediocre care as well as highlighting the many hospitals providing good and excellent care. We know there is too much variation in quality – these new in-depth inspections will allow us to get a much more detailed picture of care in hospitals than ever before. Of course we will be talking to doctors and nurses, hospital managers and patients in the hospital. But it is vital that we also hear the views of the people who have had care at any of the hospitals run by the trust, or anyone else who wants to share information with us. This will help us plan our inspection, and so help us focus on the things that really matter to people who depend on this service. This is your opportunity to tell me and my team what you think, and make a difference to NHS services in the local area.”

Sir Mike’s inspection team is expected to look in detail at A&E, Medicine, Surgery, Maternity, Out-patients, critical care and end of life care.
A full report of the inspectors’ findings will be published by the Care Quality Commission later in the year. The Trust will be one of the first to be given one of the following ratings: Outstanding, Good, Requiring improvement, or Inadequate.

Report published following independent review of maternity services
(Joint press release from NHS Cumbria CCG and NHS North Lancashire CCG (and link to the report)
An independent review of maternity services across Cumbria and North Lancashire has called on the local NHS to set up a small project team to consider the viability of having four consultant-led maternity units in Cumbria and North Lancashire.

The review was commissioned from the Royal College of Obstetricians and Gynaecologists (RCOG) during autumn 2014 by NHS Cumbria Clinical Commissioning Group (CCG) and NHS Lancashire North CCG. The purpose was to provide independent and expert advice on the best way to arrange high quality, safe and sustainable maternity services in the future. As part of the review, the team spent three days visiting maternity units in Barrow, Whitehaven, Carlisle, Kendal and Lancaster in November 2014.

The report received by the CCGs on 23 March 2015 outlines six options:

Option 1 – Four consultant-led maternity units at Carlisle, Whitehaven, Barrow and Lancaster with the immediate development of ‘alongside’ (on the same site or next to) midwifery-led units at Carlisle and Lancaster and in the longer term to evaluate the development of the same at Barrow and Whitehaven.

The report says ‘it was very clear to the assessors that women, the clinical commissioning groups and the majority of health care staff’ wish to maintain consultant-led maternity units on the four sites.
However, it says that this can only be supported on ‘safety and sustainability grounds’ if steps are taken to reform the approach to staffing, improve antenatal, labour and delivery and postnatal care, address anaesthetic issues and agree sufficient paediatric cover for a special care neonatal unit.

Medical staffing appointments to both North Cumbria University Hospitals NHS Trust and the University of Morecambe Bay NHS Foundation Trust should be made across the whole Trust, with the consultant-led units at both Trusts operating on a hub and spoke model. Clear processes and the right levels of staffing must be in place for the transfer of very high risk patients (such as multiple pregnancy or women with low lying placenta) from Furness General Hospital to Royal Lancaster Infirmary, and from West Cumberland Hospital to Cumberland Infirmary.
It says this option will require increased investment and active medical recruitment.

Liaison with larger specialist units at Newcastle and either Preston or Manchester should also be explored for the maintenance of skills.
The report says that the project team should now be established, including an external senior manager, external obstetrician, head of midwifery and patient representatives. This would be accountable to the lead clinical commissioning group and would develop a detailed feasibility report on the cost, viability and risks of proceeding with this option. Local views and social deprivation would be important considerations.

This would take place within a year and if it showed that Option 1 was not possible then Option 2 should be considered, as follows:

Option 2a – Two consultant-led units at Carlisle and Lancaster and developing two on the same site or next to midwifery-led units at Carlisle and Lancaster. This is the assessors’ second favoured option should it not be possible to achieve Option 1. It would mean the closure of consultant-led units at Whitehaven and Barrow.

The report says that while this option is more likely to provide safe levels of medical cover for women and their babies it must be balanced against increased travel times, cost and anxiety for those living in the west of the county. Antenatal care would be provided locally, including high risk consultant clinics, to minimise travelling except for the birth. The cost and benefits of this option must be balanced against the additional cost and operational pressure on the ambulance service and the need to expand the physical capacity of the consultant-led units.

Option 2b – Two consultant-led units at Carlisle and Lancaster, developing two on the same site or next to midwifery-led units at Carlisle and Lancaster and converting the consultant-led units at Whitehaven and Barrow to become ‘free-standing’ midwifery-led units, which means they have no consultant obstetric services on site. The report says that while this option increases the availability of skilled local midwifery care, when compared to Option 2a, there appeared to be little appetite for a ‘free-standing’ midwifery-led unit among women or staff. This option would need significant investment in midwifery training and leadership.

Three other options were included, none of which are recommended by the assessors.

The report recognises that for both Trusts staff recruitment and retention has been a huge problem. The most serious difficulties have been in recruiting to anaesthetics at West Cumberland Hospital and Cumberland Infirmary which has had a ‘serious impact on patient safety’. Difficulties in recruiting anaesthetists have also meant that at both Trusts some woman have not been able to have an epidural service.

It says that the range of choices for women in Cumbria could be improved by the development of Option 1. It also recognises that the geography, pockets of deprivation and poor transport infrastructure make decisions about service changes very difficult. It stresses the importance of engaging the community in the development of future arrangements.

Dr David Rogers, medical director of NHS Cumbria CCG said: “We are very grateful to Dr Falconer and his team for carrying out this review for us. We know how important maternity services are for the local population and the preferred option, Option 1, is consistent with the CCG’s commissioning intentions. However, these services need to be high quality, safe and sustainable and there is much work that needs to be done with both Trusts to overcome the significant challenges that they face. Clearly we will need to think about how we take into account the recommendations and any learning from the Kirkup report following the Morecambe Bay Investigation. We will also be sharing copies of the review report with Dr Bill Kirkup and with the team who will be carrying out the national review as announced recently by NHS England. We will also continue to talk to all local partners and the public.”

Dr Alex Gaw, chair of NHS Lancashire North CCG said: “This is a very comprehensive report which we hope will help us to resolve some of the difficult problems we have had in making sure that women and their babies receive the best possible maternity services with as much choice as possible. We now look forward to further discussions with our NHS colleagues, with local partners and the public.”

Dr Jeremy Rushmer, medical director at North Cumbria University Hospitals NHS Trust, said: “We welcome the publication of this report which clearly shows the review completed by the Royal College of Obstetricians and Gynaecologists on behalf of NHS Cumbria CCG has been wide ranging and comprehensive. As a Trust we have been very clear about our concerns relating to the sustainability of maternity services and these concerns are clearly reflected within this report. This, alongside concerns raised by the Chief Inspector of Hospitals last year, instigated this independent review process. We will now discuss the findings and recommendations with our Board and staff to understand their views and will work very closely with NHS Cumbria CCG as work progresses over the coming months on the recommendations.”

Dr David Walker, medical director, University Hospitals of Morecambe Bay NHS Foundation Trust said: “The Trust welcomes the publication of the Royal College of Obstetricians and Gynaecologists report into maternity services across Cumbria and North Lancashire. We are committed to providing a safe and effective maternity service in our hospitals, and we will now discuss the report with colleagues from our two local CCGs and from North Cumbria University Hospitals NHS Trust over the coming weeks to fully review and assess the report as a whole and understand its implications. The Trust has fully accepted the recently published Morecambe Bay Investigation report, and is committed to addressing all 18 recommendations in full. Better Care Together has already announced its intention to offer consultant-led maternity services at Furness General Hospital and the Royal Lancaster Infirmary, with midwife-led services at Westmorland General Hospital – in line with the preferred option.”

Web link to the report:–rcog-options-appraisal-final-report-(nopword).pdf
Your Cumbria, Your NHS, Your Voice : MY NHS
The scheme, MY NHS offers you the opportunities to get involved in decisions about your local health services.
By becoming a member, you will join a pool of local representatives who will be regularly consulted for their opinions on new plans, changes or what can be improved, receive updates on their special areas of interest through their personal experiences and receive invitations to focus groups, surveys and healthcare events.

MY NHS will enable you to use your experiences to influence healthcare where you live. You will be contributing to the improvement of health services delivered by the Cumbria Clinical Commissioning Group who are responsible for planning and buying NHS healthcare and health services in your geographic area. Its flexible – you can choose how you want to be communicated with and you can participate as much or as little as you like and you can choose areas of healthcare that you’re interested in:

• Support for carers
• Cancer care
• Children and young person’s health and care
• Mental health and wellbeing
• Older people’s health and care
• End of life care
• GP surgeries and primary care
• Health improvement and reducing health inequalities
• Hospital care, Long term conditions
• Community services
• Maternity and new born care
• Pharmacies and medicines
• Planned care e.g. services and treatments which are not carried out in an emergency
• Staying healthy
• Urgent Care e.g. services and treatments which are carried out in an emergency

For more information go to:
To become a member visit the website or phone: 01900 705729

Cumbria Partnership NHS Foundation Trust to show what good looks like
Two highly successful projects, in which Cumbria Partnership NHS Foundation Trust (CPFT) are a main partner, have been asked to present their best practice to other NHS organisations.
The conference, hosted by the Kings Fund, is exploring ‘what good looks like’ in community health services. This one-day conference will explore how NHS organisations can improve and develop community health services. It will also provide a forum for the sharing of good practice in community health care. The two presentations from CPFT will showcase how the Trust and the local communities have worked together to develop services in the town. Both projects involved patients, families and carers to make sure that they truly put the patient at the centre.

1. The Millom Model of healthcare which was developed following historical frustrations by the community in Millom which culminated in a march by hundreds of people through the town. They demanded better healthcare services. What followed was incredible. The new model was formed with input from the general community, patients, staff, the third sector and representatives from all NHS organisations and included:

• A community led GP recruitment campaign – video spread by the community on social media and twitter with 7000 views
• 3 doctors recruited and a 4th joining when her training ends
• A new town newspaper full of health promotion messages
• A detailed clinical model developed including:
o First advanced community paramedic in the North West
o Nurse linked to community group mobilising the population for health and wellbeing
o School plays on using the health services properly, healthy eating initiatives
o Pharmacy minor illness scheme promoted and use now highest in Cumbria
o Care homes support scheme started
o New access system in general practice
• Community hospital reopened and significant reduction in Length of stay.

John Howarth Director of Service Improvement at CPFT said “The general practice in Millom looks after 8500 patients yet there are 17,600 journeys out of the town every year for an appointment taking 50 minutes each way on poor roads. Our approach is to develop more and more services in Millom itself and connect Millom up using the latest technology so patients don’t have to travel. The Kings Fund in London are especially interested in how we have moved from public anger and marches in the streets to a great partnership with the community. I’d like to pay tribute to the Millom Action Group, the Millom League of Friends and patient groups. They care passionately about their community and have worked tirelessly with us to make things better. The Millom approach shows just how much can be achieved when health organisations, social care and the public get onto the same side in an open and transparent way.”

2. The Love Barrow Families project details
Love Barrow Families is a project that aimed to create a way of working with families with the most complex needs in the community to really make a difference.
Since the idea was put forward over two years ago the Love Barrow Team have worked tirelessly to create a team and a way of working that supports the whole family, assessing their real needs and discovering the skills and assets of the people in that family and those surrounding them to produce a specially targeted package of support.

Trina Robson who is the project lead for Love Barrow Families explained “We have daily contact with the families we are working with giving practical emotional support to people who are often in crisis. We do this without judgment and with consistency. The families have developed extremely positive working relationships with the professionals involved in the project and there have been many examples of massive progress being made by families who have often struggled for many years and have responded positively to a different way of working. Each family have their own goals which they are working towards and some of our families are now able to assist the project through developing community activities, sitting on our project board and joining us in presenting what we do to other agencies/communities. Also as well as creating a new way of working with the families the Love Barrow team has had to persuade professionals to take a different approach.”
The Kings Fund event takes place on 26th March in London.

Keep it Local for Better Services
The umbrella body Locality has said it is “time to bust the myth that bigger is better” and called on the government to make it easier for smaller organisations to win public service delivery contracts. Its call comes in a report published today as part of the launch of Locality’s Keep it Local campaign, which calls for public services to be run by local organisations rather than large private sector companies.

The report, Keep it Local for Better Services, says: “The false belief in economies of scale and standardisation of services is the problem, not the solution.
“Large-scale standardised services don’t solve people’s problems. They do lead to a drop in quality and a rise in costs.”
The paper calls on the government to ensure that public service contracts are built around the needs of the local community and include a presumption that the contract will be delivered locally at the most appropriate size. It says the government should legislate to ensure that no single supplier is able to take more than 20 per cent of a public body’s budget or have more than a 20 per cent share of a public service market. The government should, it says, develop new measures to ensure equality of opportunity in all public service contracting and to remove any structural barriers that prevent community organisations from bidding.

The report says the government should make transparency a requirement of all public service contracting and delivery organisations should provide details about how they are fulfilling contracts and the social value that is offered. Research carried out by the polling company YouGov for the report found that 72 per cent of people though public services should be run by locally based organisations. It found that 32 per cent of people felt that public services were not meeting all their needs, and 83 per cent feared that some public services would cease to exist or would no longer be free of charge.

Tony Armstrong, chief executive of Locality, said the system for contracting out public services was letting people down.
“Our polling results show overwhelming support for our Keep it Local campaign,” he said. “People are fed up of their taxes being pocketed by massive national companies that give them a tawdry deal. They don’t want one-size-fits-all services provided by large organisations that work across huge swathes of the country. They want community-focused services designed and delivered at a local level by people who know them and can give them what they need. It’s time the government put communities at the heart of public service commissioning and delivery.”

Web link to the report:

A couple of articles from Voluntary Sector North West’s Health e-bulletin…

NHS England Model Grant Agreement (between CCG’s and Third Sector Organisations)
Grants can be used to provide financial support to a voluntary organisation which provides or arranges for the provision of services which are similar to those in respect of which the CCG has statutory functions. NHS England has published a Grant Agreement, Guidance on the use of the draft model Grant Funding Agreement and a Bitesize Guide.
The model grant agreement is non-mandatory and is for local adaptation as required. We are committed to working alongside commissioners and the voluntary sector to inform the development of future resources. If you have any feedback or suggestions, or would like to be involved please contact
Web link:

Consultation – Strengthening rights and choices for people to live in the community
The document ‘No voice unheard, no right ignored’ seeks to explore views on a number of issues relating to the Mental Health Act which were raised during the recent consultation on the revised Mental Health Act Code of Practice. This consultation closes on 29th May.
More information:

LGA: A short guide to Purdah during the pre-election period
A useful guide produced by the LGA for local authorities explaining what they can and can’t do from a publicity perspective. Download the guide:

Web link to the newsletter:

Jozi Brown
Senior Engagement Officer
Cumbria CVS