• Grantham A&E night time closure will not face Independent Reconfiguration Panel probe
  • Trust’s decision to close on safety grounds backed by IRP but communication criticised
  • Move should no longer be referred to as “temporary” and “honest debate” needed

The overnight closure of Grantham and District Hospital’s accident and emergency will not face a full investigation by the Independent Reconfiguration Panel.

The panel’s long awaited assessment said it backed United Lincolnshire Hospitals Trust’s decision to close the A&E at night on safety grounds, but criticised the trust and other public service providers’ communication of the move to politicians and the public.

The panel, which investigates contested reconfigurations for the Department of Health, said “open and honest” debate was needed to resolve the small A&E’s future, which was “currently fundamentally unclear”.

The panel also said the closure can “no longer be regarded as a temporary” and “it [was] not in the interests of patients that future discussions be conducted on this basis”.

The A&E, one of the smallest in the country, had already been “more akin to that of an urgent care centre” before the night time closure and “unrealistic expectations and misunderstanding may have been allowed to develop about the level of service” it could provide, the panel said.

The initial assessment, signed by panel chair Lord Ribeiro, said: “The panel agrees that in the interests of safety the A&E service at Grantham and District Hospital should not reopen 24/7 unless sufficient staff defined by the threshold can be recruited and retained.

“The panel considers that the time has come for an open and honest appraisal both of the options for future emergency care delivery at Grantham and more widely across Lincolnshire.”

The assessment, accepted by health secretary Jeremy Hunt, followed the closure being referred to the panel by Lincolnshire county council in November.

The process has been closely watched by the rest of the NHS with many sustainability and transformation plans involving significant urgent and emergency care reconfiguration plans. A full investigation would have been a major blow to the trust and could have taken decision making out of its hands.

Grantham A&E has reduced its opening hours to be closed from 6.30pm to 9am since August 2016. The trust has consistently said the move was “temporary” and it would reopen 24/7 when safe staffing ratios could be met.

Council leader Martin Hill said the panel’s conclusion was “disappointing” and “the fear that this ‘temporary closure’ would be anything but temporary has proved to be entirely founded.

“It is unacceptable that Grantham district has had a substantial change to hospital services for over a year without proper consultation or planning. I would urge NHS partners to start that process urgently so that local people can have some certainty about the future.”

The panel was critical of the trust’s handling of the communication of the closure and issues surrounding it, and for not raising the matter with the council earlier.

It said: “Clearly the crisis that arose did not happen overnight yet it appears the [council health select committee] was only advised of circumstances once decisions had been made and action taken. The panel would have expected that, as part of the exchange of information that should be taking place regularly, the [council] would have been advised of the situation earlier.”

The appraisal added “the absence of ongoing communication might have helped to fuel the view that the temporary closure was to be continued indefinitely until made permanent”.

United Lincolnshire’s medical director Neill Hepburn said:  “We are pleased with the Independent Reconfiguration Panel and secretary of state for health’s decision not to undertake a full review into the overnight closure of Grantham A&E.

“We are also pleased they agreed with the trust that in the interests of patient safety, we shouldn’t fully reopen Grantham A&E unless there is sufficient staff. The trust remains committed to fully reopening Grantham A&E but only when safe to do so.

“At our recent board meeting, we agreed to work with CCGs to explore an interim service model for a 24 hour emergency/out of hours service before November. We will continue to engage local residents and councillors, alongside CCGs, in designing an urgent care service.”