Liverpool reconfiguration plans unveiled

The prospect of further centralising cancer services at the Royal is outlined in a “prospectus” for the Healthy Liverpool programme, approved this week by Liverpool Clinical Commissioning Group.

It sets out the programme’s support for concentrating Cheshire and Merseyside’s major trauma services, which are currently split between the Royal Liverpool site and that of Aintree University Hospital, on to a single site.

The document is the product of the first year of Healthy Liverpool, which the CCG says has involved hundreds of local clinicians in developing the models that could drive change to the city’s services.

The programme is at an early stage and will not produce options for formal public consultation before the 2015 general election. But the prospectus gives the clearest indication so far of the kind of changes under consideration.

It notes that oncology and radiotherapy specialist The Clatterbridge Cancer Centre Foundation Trust is out to public consultation on plans to develop a new centre to house all its inpatient beds on the Royal site.

However, while this would “provide a concentration of the majority of cancer services”, cancer surgery remains split between a number of specialist and teaching hospitals: the Royal; Aintree; Liverpool Women’s Hospital FT; Liverpool Heart and Chest Hospital FT; Alder Hey Children’s FT; and neurosciences specialist the Walton Centre FT.

“If the city’s ambition is to truly become a world class centre of excellence for cancer care, treatment and research,” the document states, “it is appropriate to consider the case for the relocation of surgical cancer services onto the new central campus at the Royal Liverpool Hospital.”

Concentrating the “majority of cancer surgery” at the Royal would allow better coordination of care pathways, better access to specialists from other disciplines, and closer integration of the NHS and Liverpool University’s research teams, it states.

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However, it acknowledges that there is a “strong clinical case” for retaining some cancer surgery at other specialist sites, highlighting Alder Hey and the Walton Centre.

The document also proposes concentrating all adult major trauma services for Cheshire and Merseyside on a single site.

Liverpool currently has an unusual arrangement, in which major trauma services are provided by a “collaborative” of the Royal Liverpool, Aintree and the Walton Centre, albeit with the latter two hospitals based on the same site.

Liverpool CCG chief officer Katherine Sheerin said there was strong support from clinicians for a single major trauma centre.

“All the work we’ve done on service models has been driven by the clinicians from the providers involved,” she told HSJ.

“The one that’s most advanced is urgent and emergency care. I think there’s pretty strong consensus from the clinicians involved that… what we need is to move to a trauma centre model, with a proper trauma centre.”

But she highlighted that there were other specialist emergency services besides major trauma, such as those for strokes or heart attacks, and added: “We’re not saying that they [should necessarily] all go onto the same site. That absolutely hasn’t been said yet.”

Options for the future shape of those other specialist emergency services is expected to be the subject of further work by clinicians in coming months.

The third major area of acute care where Healthy Liverpool may recommend changes is women’s and maternity care. Liverpool is the only city in England where the bulk of these services are provided at a standalone women’s hospital, which is physically separate from other adult services and specialist paediatric services.

The prospectus states clinicians at Liverpool Women’s Hospital are now “leading a review to explore how services for women could be improved to deliver even better outcomes”.

One of the challenges this review will address is access to general adult and paediatric acute services.

“There are a growing number of pregnant women with more complex health needs who need to be safely transferred by ambulance for treatment at a local acute hospital, often to the Royal Liverpool,” the document explains. Access to specialist paediatric services “presents similar challenges”.

Ms Sheerin said work to explore possible changes to women’s and maternity services was at an early stage, and it was highlighted in the prospectus in order to “start the dialogue with the people of Liverpool about the need to consider some of the [possible] changes”.

But she added that the options for maternity care were essentially either to leave it separate from other services and “understand the implications of leaving it like that, both financially and clinically”; to move it to be co-located with other adult acute services; or to move it to be co-located with the children’s hospital.

Commissioners plan to launch the prospectus next month, and to begin a city-wide engagement programme on the “case for change” in January. This will inform the development of options for reconfiguration, ahead of a possible public consultation next summer.

“This is a real opportunity for us in Liverpool,” Ms Sheerin told HSJ. “We’re financially balanced. We’ve got the resources to do it at the moment, [we can] make the investment where it’s needed [to change services].

“If we don’t get on with it now we could be in a different place in three or four years’ time.”