Blood pressures rocketed when doctors queued up to tell the council: ‘You’re putting patients at risk’.

Cheshire West and Chester Council is transferring sexual health services from the Countess of Chester Hospital to Macclesfield-based East Cheshire NHS, with the intention of achieving high quality uniform standards across the whole borough and improving access in the rural area.

But the Tory-run authority was accused of treating the contract as though it was for a bin collection or a cleaning contract at its health and well-being scrutiny committee, leading to an acceptance it must ‘learn lessons’.

Doctors, a patient with HIV and several councillors were concerned the ‘excellent’ Countess-based service would be dismantled when it could simply have been rolled out to cover the whole of West Cheshire.

Countess-based sexual health consultant Dr Colm O’Mahony said: “The team that looks after HIV will now be disintegrated. We have a five day a week expert service at the Countess of Chester Hospital for any patients with HIV or HIV-related issues.

“My colleagues constantly come up with problems in gynaecology, dermatology, paediatrics that need our discussion, now we’re not sure what’s going to happen with the team.

“We think East will allow the Countess to buy back some sessional time so that myself and some of the doctors can do one or two clinics a week at the Countess, but that is not a full, safe service.”

Dr Colm O'Mahony
 

He remains puzzled why the initial East bid won despite exceeding the £2.4m threshold. After protests, a second tender was run with a higher £2.8m limit and again the East triumphed at a cost of £2.75m – compared with his team’s £2.5m bid.

Dr O’Mahony said their bid was put together by five consultants from the Countess and Leighton Hospitals while the rival bid was compiled by a management firm with limited staff input.

Dr O’Mahony was now embroiled in a costly and ‘massive’ reorganisation of ‘no patient benefit’ because the new contract begins in just three weeks’ time, on February 1. More than 50 staff were having to transfer across to the new service whereas just five would have gone the other way if the Countess had won.

Dr Natalie Meara, a consultant histopathologist at the Countess, reminded the council of just what was at stake.

She said: “I’m here representing doctors who have a duty to protect patients. I’m here as a woman who has sex and I’m here as a mother of two children who I wish to protect as any mother should.

“Having sex is not without risk of disease, including cancer and unwanted pregnancy. Most adults have sex and those that are not having sex, at some point, would like to have sex.

“More and more children are having sex and some of those children do not want to have sex. Sexual health therefore impacts on most of our local population and it’s one of the most important areas the council are now charged with overseeing.”

Having seen people dying of AIDS when training at St Thomas’ Hospital in London, she now fears increased risks for patients with HIV and does not feel reassured the proposed model will improve safeguarding arrangements for vulnerable children.

One HIV patient, who addressed the committee, said he was only ‘here’ because of the support of Dr O’Mahony and his team over the years. He said service users were ‘aghast’ and ‘deeply upset’ about what was happening.

Consultant paediatrician Dr John Gibbs said the council will compromise the care of patients, especially the most vulnerable, who need hospital support, such a babies born to mothers with HIV.

He said a council-commissioned survey showed an 81% approval rating among users of the existing service. What ‘little’ feedback he could find about the new provider was ‘highly negative’.

Dr Huw Charles-Jones, chairman of NHS West Cheshire Clinical Commissioning Group (CCG) and a Lache GP, told the committee: “At the CCG we didn’t know much about this, I think you can spin this all you like, but I wish someone could just be honest here and say the tendering process was flawed because there was no clinical involvement and the consultation was very poor. I don’t know why you can’t just say that and then we can move on and look to the future.”

Dr Charles-Jones was unimpressed the evaluation of the competing tenders was ‘a paper exercise’ with ‘administrators looking at tender documents’ instead of interviewing the bidders.

“You are talking about the health service here and in the health service it is common practice. It does change the sense of what’s going to be delivered by seeing the people and talking to them. We’re almost forgetting about the patients here. This is about people’s lives. This is about people’s health.”

Labour Cllr Marie Nelson said: “There’s no understanding whatsoever in this authority of the difference between a cleaning contract and a public health contract and I’m totally and utterly ashamed.

“We know we had an outstanding service at the Countess, there’s no reason why that outstanding service couldn’t have been rolled out to the rest of the authority.”

Cllr Nelson wanted to know who had made the decision because they should be accountable for their actions. For legal reasons, the council is unwilling to divulge the names of the evaluation panel.

John Wilbraham, chief executive of East Cheshire NHS Trust, entered what the chairman called ‘the lion’s den’ in an attempt to reassure everyone in the room.

He said: ”It’s my job to ensure some of the concerns heard this evening do not happen and I’m committed to ensuring the provision of sexual health services in Cheshire West and Chester maintains, and hopefully improves on, the excellent standards that are currently provided.”

Mr Wilbraham said the current provider and his own team had been working hard to ensure the transfer takes place ‘as seamlessly as possible’ but conceded the new Chester base in the Fountains building would not be ready for the start of the contract. He thanked Countess chief executive Tony Chambers for allowing the new team to work at the city hospital for two weeks until they could move in.

He said: “It’s important for you to understand and recognise that the clinical staff that currently operate from the Countess will actually be operating in the new service. They will be transferring, providing they wish to. Concerns around clinical continuity and clinical expertise, I don’t believe that is an issue for you.”

He denied the decision to operate from the Fountains building had been copied from the Countess bid and said extra elements of the new service included working from additional sites and extended opening hours. Mr Wilbraham insisted there would be integration with the HIV service at the Countess.

Scrutiny committee Conservative chairman Cllr Don Hammond concluded: “We will make recommendations for more co-commissioning, we will look at the way this contract gets implemented and we will work more closely with the CCGs, NHS England and our partners in how we look at these tenders in the future, but I know we have an objective of having an equal service across the borough.”