An Open Letter to Mr Andy Williams, the CEO of the three Clinical Commissioning Groups ( CCGs) responsible for commissioning health services across Leicester, Leicestershire and Rutland ( LLR)

Dear Mr Williams

"New plans for Leicester hospitals ignore the implications for healthcare in Rutland."

We understand that at the end of September you will be writing to every household to launch public consultation on changes at Leicester Hospitals.

As you can imagine, proposals which include the closure of all beds (including the Obstetric Unit) at Leicester General Hospital and the Birthing Centre at St Mary's Hospital, Melton Mowbray will worry the Rutland population and need to be considered very seriously. As you will see from this letter it makes Rutland people angry lest our county, its inhabitants and their needs are simply forgotten or dismissed.

Therefore release of the Pre Consultation Business Case (PCBC*- how to obtain a copy at the end of this letter) on 1st September was a key moment. For the first time the details of the proposals were available to Rutlanders.

The Rutland Health & Social Care Policy Consortium is a group of Rutlanders experienced in working in and with the NHS. We have had a first read through of the 1,600 plus pages and are setting out below our initial comments on the proposals as a first contribution to the debate. We anticipate making more detailed comments at a later date as we study the PCBC in detail.

After six years of planning (started in 2014) it is disappointing that the PCBC proposals are largely limited to reconfiguration of Leicester hospitals. Their main focus is the closure of all beds at Leicester General Hospital (LGH) with maternity moving to a new greatly expanded maternity hospital (capable of 11,000 deliveries) at Leicester Royal Infirmary (LRI).

Beds will be redistributed between Glenfield and the Royal and planned (elective) procedures will move to a new unit at Glenfield Hospital (GH). There is one proposal to retain a midwife unit at LGH for a period of 12 months but to shut it if births do not reach 500 in the first year.

Reassuringly, and reflecting the National Long Term Plan (January 2019) LLR have separately stated their intention to keep care as close as possible to home. No proposals are put forward for compensating services within Rutland. Instead the document does say that in terms of transport the whole of Rutland will be disadvantaged by these proposals.

As health commentators, we consider it is a missed opportunity to redesign acute and community services together and would urge the Clinical Commissioning Groups, even at this late hour, to bring forward proposals for community services (including for Rutland Memorial Hospital). Indeed Rutlanders feel so strongly about the need for a whole system approach that in September 2019 a group of about 100 met in Oakham and mapped out " A Health Plan for Rutland " and sent it to you.

This plan produced by Rutlanders closely reflects government policy as outlined in the National Long Term Plan (2019) and includes modernising of facilities at Rutland Memorial to help keep residents from having to be admitted to hospital or to enable their early discharge. It recognises that acute and community care are flip sides of the same coin and strengthened primary and community services can keep people out of hospital – a lesson not lost during Covid.

Although " A Health Plan for Rutland " was welcomed and an official local plan for Rutland was promised in January 2020 here we are nine months later with nothing published so all that is on offer is closure.

Consultation is planned to start at the end of September on the proposals to combine three hospitals into two by transferring services from Leicester General to Glenfield and the Royal retaining only a few services on the LGH site, selling off most of the site for housing.

The PCBC tells us that if Rutlanders find difficulty travelling the extra distance to LRI or GH they can go elsewhere. Peterborough and Kettering are not equivalent options. They are not teaching hospitals like Leicester which offers secondary and tertiary (specialist) care and has a reputation for excellence in research.

While Peterborough and Kettering Trusts offer secondary care, those needing specialist care may be referred on to Addenbrookes or the Oxford Hospitals. It is imperative that Rutlanders are given good quality information to know what they are being offered in order to make informed decisions. Alternatives are possible but must be made explicit before consultation commences.

We urge Rutlanders to seek that information and we urge you to describe what you plan in the community before they are asked to respond to what appear simple questions on the closure of one acute hospital and two maternity units. This will be the biggest change to health services for Rutlanders in many generations and cannot be reduced to a tick box exercise because the decision has far reaching consequences.

Engagement out here has been so limited that one person commented that our community's work on its health plan was the only piece of real engagement they had experienced . For that reason we would urge you to take account of their knowledge of living in a sparsely populated area and engage with them to develop plans.

To give just a few examples of problems with the PCBC:-

Transport. You have used a computer package to assess travel times and conclude that the whole of Rutland will be disadvantaged by the move but that it will only involve an increased journey of 10 minutes. Rule of thumb for most Rutlanders is 40 minutes to LGH and one and a half hours to LRI.

As we pass the outskirts, we soon find out why Leicester is the tenth most congested city in England! Many older people will not even try to drive to LRI or GH and taxis are of the order of £100.

To give you a feel of the reality of public transport let us look at getting from a Rutland village to Glenfield for a 9.00 am appointment. It requires a 6.54 departure, three bus journeys and 30 minutes walking, some 1h55m.

Return journey assuming the appointment is over at say 11.00 am. Departure would be at 11.33, bus, train, bus and 15 minutes walk so some 1h40m in total.

Public "Engagement" CCG staff are always welcome in Rutland but there has been only one meeting to discuss UHL proposals . Glossy artists' impressions were presented but no detail then discussion of the implications was abruptly cut short before people's questions could be answered. For most people these are completely new proposals so please leave the glossy presentations at home and talk with us not at us.

Legal requirements. There is a legal requirement to consult with the public. The CCGs have already decided they would fail to meet their obligations when transferring a substantial proportion of Leicester General to Glenfield despite urging by the combined LLR Scrutiny Committee to comply. Such disregard of legal obligations and possible prejudice of this consultation breeds distrust.

Maternity. Most of the public engagement took place in Leicester. There was just one event on 17th July 2015 in Rutland but only 6 members of the public (and no mothers) were involved. Rutland people have not had an adequate say in the redesign of Maternity Services serving Rutland.

In conclusion

We look forward to constructive discussion of some very serious changes and we hope you are willing to supply the whole picture of where these changes fit into the wider picture of primary, community, acute ( including physical and Mental Health) and social care.

You are our commissioner of health services and we look forward to working with you to develop a proposal that works for Rutland. Some of the narrative in the PCBC dismisses our minority rural population as unimportant and we are sure that you personally do not see things that way .

Yours sincerely

The Rutland Health & Social Care Policy Consortium

PS - The PCBC can be found on the agenda for the East Leicestershire and Rutland CCG meeting of 8th September

https://eastleicestershireandrutlandccg.nhs.uk