Ward closure 'real-world impact' of finances

The closure of a hospital ward is among the "real-world impacts" of the difficulties facing a hospital trust in "financial special measures", its chief executive has told a board meeting.
Lancashire Teaching Hospitals NHS Foundation Trust (LTH) which runs Chorley and South Ribble Hospital is funded by the Lancashire and South Cumbria Integrated Care Board (ICB).
The ICB has to make more than £530m in efficiency savings this financial year.
Staff on the Cuerden ward at the Chorley hospital were told last month the 24-bed facility, which is less than three years old, would shut at the end of March.
The Cuerden ward building opened in July 2022 to provide additional space for diabetes, endocrinology and other general medical patients, the Local Democracy Reporting Service said.
Confirming the closure last month, LTH said it was part of the process of "flexing" how many beds were open according to demand, which is greatest during the winter.
However, Silas Nicholls, LTH boss acknowledged at a board meeting on Thursday the "difficult decision" also had its roots in the budgetary pressure the trust is under.
Just days earlier LTH had been placed by NHS England into the equivalent of financial special measures officially known as NHS oversight framework segment 4 along with East Lancashire Hospitals Trust, Blackpool Teaching Hospitals NHS Foundation Trust and the overarching ICB.
All of those organisations will now receive "intensive support" to recover their financial positions.
Referring to the Cuerden ward closure, Mr Nicholls said it was also the result of the fact the facility had initially been funded by additional money pumped into the NHS to deal with Covid pressures earlier in the pandemic.
One of its initial uses was to assist with patient flow through the hospital system and provide beds for those close to being discharged.
He told board members "good progress" was being made in attempts to avoid redundancies and redeploy staff in the wake of the ward closing.
"We are working to make sure that no staff lose their jobs over this," he said.
Mr Nicholls said the aim was to repurpose the modular-designed building for another use, rather than leave it vacant.
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Hospital trusts in 'financial special measures'
Lancashire Teaching Hospitals NHS Foundation Trust

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There is no mention on Hope Clinic's website or Instagram page of the viability restriction in Illinois law or its health and life exemptions. 'It would be impossible to list for folks every single … criteria to meet a health exception. It would be an untenable list of things on a website or Instagram,' King said. 'We absolutely do a very careful review of medical history, just like we would for any medical patient. History, both physical and social history, all the very things that go into seeing a patient.' King said that if patients past the point of fetal viability don't meet a health exception then 'we do not see them,' and they would have to be referred to another provider. There are other states with no gestational limits or viability restrictions, including New Mexico, Alaska, Colorado, Maryland, Minnesota, Michigan, New Jersey, Vermont and Oregon, as well as Washington, D.C., according to the Guttmacher Institute, a pro-reproductive rights research group. But only a few clinics nationwide offer abortions in the third trimester, including DuPont Clinic in Washington, D.C., VAG Clinic in New Mexico and Partners in Abortion Care in Maryland. 'Right now, if you're looking at all-trimester providers, there's very few across the country and patients have to (travel) very long distances to get there,' King said. The physician anticipates that more than half of the patients at the new Uptown clinic will be traveling from other states. Since the demise of Roe, a surge of out-of-state patients have been coming to Illinois to have abortions, sometimes later gestationally because of longer travel distances and wait times for appointments. In 2024, Illinois provided roughly 35,000 abortions to patients from other states, ranking as the state with the highest number of out-of-state abortions for the second year in a row, according to the Guttmacher Institute. 'Abortion bans themselves deny people access to care on the timeline they desire, furthering the need for abortion care later in pregnancy,' said Megan Jeyifo, executive director of the Chicago Abortion Fund. 'More abortion seekers are being pushed further into pregnancy before they can access appointments, which is why expansions like this are so critical.' Illinois abortion providers have also reported a spike in patients with complicated medical issues requiring hospital care that freestanding clinics can't offer. In response, Illinois in 2023 launched the Complex Abortion Regional Line for Access, which includes a hotline staffed by a nurse to help patients schedule abortion appointments in local hospital systems. King said the new clinic is trying to ease that burden by treating patients later in pregnancy who are appropriate for outpatient-based care, so hospitals can focus on the most medically complicated cases. But Zander of Illinois Right to Life said she doesn't believe most Illinois voters intended for the law to permit abortions so late in pregnancy. 'The state of Illinois is trying to do some sort of work-around where they're saying OK, elective third trimester abortion is not legal because we know that Americans don't really like that and that's not palatable even for pro-choice people,' she said. 'But we'll allow so many excuses … they make the definition of medical reasons so incredibly vast and vague that any woman could find herself in a doctor's medical office convincing that doctor she has a medical reason to have an abortion … even if the threat to her life does not exist. And that's political.' For nearly a half-century, the concept of fetal viability was a cornerstone of Roe until roughly three years ago, when the landmark 1973 case was overturned by Dobbs v. Jackson Women's Health Organization. 'With respect to the State's important and legitimate interest in potential life, the 'compelling' point is at viability,' the high court ruled in Roe. 'This is so because the fetus then presumably has the capability of meaningful life outside the mother's womb.' The original version of the Illinois Reproductive Health Act included no gestational limit or viability restriction, leaving the decision of when during pregnancy an abortion can be performed to the patient and medical provider. Around the same time, President Donald Trump targeted abortions late in pregnancy during his February 2019 State of the Union Address. 'To defend the dignity of every person, I am asking the Congress to pass legislation to prohibit the late-term abortion of children who can feel pain in the mother's womb,' he said. 'Let us work together to build a culture that cherishes innocent life.' In March 2019, throngs of abortion opponents protested the Illinois measure, filling the state capitol to blast the bill. Several anti-abortion groups warned in a joint news release that if the legislation were enacted, 'Illinois would become a third-trimester abortion destination.' Yet there was a simultaneous groundswell in favor of the measure, which enshrined abortion as a 'fundamental right' in Illinois law. The support came amid a wave of conservative states passing so-called heartbeat bills limiting abortion to about the first six weeks, before many know they're pregnant. Reproductive rights supporters protested these abortion bans at Federal Plaza in May 2019, some holding signs calling for 'abortion on demand.' Before Pritzker signed the Reproductive Health Act in June 2019, legislators amended the language to include the viability restriction. But medical experts say fetal viability can be a complicated concept in practice. The American College of Obstetricians and Gynecologists opposes using viability as a standard in the legislation or regulation of abortion. 'Viability is just one factor that patients and health care professionals use when considering whether to proceed with or end a pregnancy, and gestational age is only one factor considered when estimating viability,' the organization said in a statement. 'Legislative bans on abortion care often overlook unique patient needs, medical evidence, individual facts in a given case, and the inherent uncertainty of outcomes in favor of defining viability solely by gestational ages.' While King said she complies with Illinois law, she is critical of viability restrictions as well as gestational limits. 'Any restriction around abortion access disproportionately affects people that already have difficulty accessing any health care … the most marginalized folks,' she said. 'People who have lower incomes. People from health deserts. People experiencing inequities in health care due to their race.' Terminations later in pregnancy tend to be rare, with 79% performed at nine weeks or earlier and 93% occurring in the first 13 weeks, according to the Centers for Disease Control and Prevention data from 2022. Only 1% were performed at or after 21 weeks, though some criticize the CDC data as incomplete because it includes limited areas that report abortions by gestational age and excludes major states such as California and New York, according to KFF, formerly the Kaiser Family Foundation. While abortions later in pregnancy are uncommon relative to earlier terminations, 'that doesn't mean it's not essential health care,' said Sarah Garza Resnick, president and CEO of the reproductive rights advocacy group Personal PAC. 'At no point in any pregnancy does the government know more about my body than me or my doctor,' she said. 'People need later care and they need trusted clinics, like Hope, to provide that care.' On the other end of the spectrum, abortion opponents argue that fetal viability is a moving target because, with advancing medical interventions, babies are born at earlier gestational stages compared to when Roe was decided. 'We regularly see babies born at 24 weeks who go on to live,' Zander said. During an interview with the Tribune after Roe fell, Dr. Karen Deighan recounted how ultrasounds and other technology have ameliorated over the years, solidifying her belief that life begins at conception. 'You can see very early the heart, all the organs, the head, the eyes, the movement. You can see the baby inside,' said Deighan, then an associate professor of obstetrics and gynecology at Loyola University Medical Center. 'I struggle sometimes, because some of my colleagues will work so hard to protect and save a 22-week peri-viable pregnancy. … And then don't see a problem with someone choosing to end that pregnancy.' Scheidler of the Pro-Life Action League called the new Chicago clinic an example of the 'increasing radicalization of abortion advocates.' 'We used to hear talk about abortion being safe, legal and rare. Being an anguished decision,' he said. 'The way our state has been going, it's going to become the abortion capital of the United States. That's what's happening.'