Board Meeting of the Governing Bodies Ossett Town Hall 25 July 2013.

Board Meeting of the Governing Bodies

Ossett Town Hall25 July 2013

Dr Phil Earnshaw

Chair

NHS Wakefield Clinical Commissioning Group

Dr David Kelly

Chair

NHS North Kirklees

Clinical Commissioning Group

Key reasons for change

• To provide better outcomes for patients and safe, excellent quality services

• To improve the health of local people

• To meet greater and different demands – rising populations and more older people

• To provide more care in community settings – which benefits patients

• To meet workforce challenges

• To make best use of taxpayers’ money

Mid Yorkshire Health & Social Care Partnership Transformation Programme

Clinical Services Strategy

Care closer to

home

Urgent care

Maternity, children & young people

Mental health & learning disability

2010 • Independent clinical reviews

2011 • 5 options

2012 • 2 options

2013 • One set of proposals • CONSULTATION

Development of the Clinical Services Strategy

Dr Simon Enright

The Mid Yorkshire Hospitals NHS Trust

Consultant and Lead Clinician (CSS)

Dewsbury midwife-led unit‘low risk’ : home, midwife unit or Pinderfields‘high risk’: deliver at Pinderfields

Pinderfields ‘high risk’ births: all to consultant-led unit‘low risk’ births: home, midwife-led unit

Pontefract no change: midwife-led unit‘low risk’: home, midwife unit or Pinderfields‘high risk’: deliver at Pinderfields Local antenatal/postnatal care

Maternity services – the proposals

Children’s services – the proposals

Dewsbury : • New assessment facility for children who attend A&E • Majority of current inpatients through new facility • Those requiring longer inpatient care at Pinderfields

Pinderfields: no change

Pontefract: no change

Urgent assessment and outpatients at all 3 hospitals

Emergency care – the proposals

Dewsbury• open access for emergency care (70% of current)• staffed by A&E trained doctors and nurses (24/7)• full resuscitation facilities • able to treat a wide range of conditions • some ambulance attendances• consultants on site 9am to 8pm and on call 24/7

• “Emergency Day Care” on site to reduce need for admission

Emergency care (contd)

Pontefract• as now, open access for emergency care• full resuscitation facilities • able to treat a wide range of conditions • some ambulance attendances• Consultants on site during the day and on call 24/7

Pinderfields• specialist trauma and emergency care centre for Mid

Yorkshire• centre for emergencies needing inpatient care

Surgery – the proposalsDewsbury • Planned inpatient surgery (more specialties)• Day surgery • Some unplanned surgery

Pinderfields • Emergency surgery, complex surgery (critical care)• Day surgery

Pontefract • Planned orthopaedics, ophthalmology (from 2013)• Range of inpatient short stay surgery• Day surgery

Pat Keane

Interim Programme DirectorMeeting the Challenge

Quality Impact Assessment/

Integrated Impact Assessment

Presentation for Joint CCG Board meeting

Graeme Wilson

Ossett Town Hall 25 July 2013

How views were gathered

• Consultation document response (post and online)

• Representative poll of the population• Focus groups on specific issues• Campaigns and petitions• Public meetings, interest groups and

stakeholder response• Deliberative event with representatives

from community, voluntary and patients groups

Key Quantitative data

Consultation document response• Overall 29% think it will achieve

its aims, 29% think it will not• 38% disagree with some aspect• 45% believe there are other

options to considerPhone poll• 49% overall quite or very

concerned

By area

Area Wakefield North Kirklees

Leeds

Achieve its aims

33% 22% 44%

Disagree with aspects

30% 51% 27%

Other options to consider

43% 50% 38%

Phone PollQuite or very concerned

40% 67% 31%

Three recurring themes

• Access to care - ability to access appointments, and the location of services relative to locality

• Transport –perceived difficulty in getting to services, relatives ability to visit, and negotiating the local transport network.

• Specific hospitals – the ability of Pinderfields to cope, the impact on care in Dewsbury and viability of Dewsbury in the long term

Access to Care

Themes are related to locality of services• Moving services from Dewsbury diminishes my

local options

• Getting to specialists in an emergency is more difficult and feels like more of a risk

• Planned procedures and births that have difficulties are further from Specialists creating risk

• Increase in use of Pinderfields will mean that my waiting times will get longer and booking appointments more difficult

Specific hospitals

Themes relate to the viability of the services• Worries on Pinderfields ability to cope both in

terms of staffing and in operational areas such as parking

• Worries about the long term viability of Dewsbury hospital with the removal of services

• Why Pinderfields and not Dewsbury?

• The availability of health services at Pontefract including consultant led A&E

Transport

The themes relate to locality and access• Specialist services in Pinderfields means

inconvenience and barriers through transport and travel implications

• Families and visitors will have to travel more in the new configuration

• The impact on vulnerable members of the community and those without private transport may be significant

• There are concerns over emergency transfers and time to A&E in emergency creating additional risk

Priorities for care

• A&E – well equipped ambulances and response times

• Maternity – local services and access to specialists

• Surgery and outpatients – access to specialists and fewer cancellations

• Children’s services – access to specialists and local outpatients appointments

• Transport – Public transport infrastructure and car parking

Overall

• There is significant concern that relate to ability to Access Services, the implications for Specific Hospitals and the Transport consequences of the proposals

• All residents share these concerns although they are more acutely felt in North Kirklees

• There has been significant and vocal opposition from campaigns and stakeholders in this process, again particularly in North Kirklees

Deliberative event

Recommendations• Communication on what exists to build

confidence that community care is suitable

• A realisable model of community care• 24/7 GPs on rota with access to records• Communication related to outcomes not

changes• Effective communication and

engagement to ensure community understand changes

• Personalised health budgets and planning

Conclusions

• Decision makers should be aware of the persistent concerns raised

• There is further work to be done to reassure people over the impact of the changes

• Clear process to monitor any change and its real impact over time

• Effective and consistent communication to address anxieties

• Realising the objectives set out is likely to make the population more positive about the changes

Questions from the Governing Bodies

Martin Carter

Head of Communications & Engagement

Meeting the Challenge

Established to oversee consultation output as it emerged

Key tasks:• to assess impact of any major concerns and challenges to

clinical case – gaining assurance where appropriate

• to advise the CCGs if any issue had arisen which would mean extending or re-opening consultation

• to assess the robustness and effectiveness of the consultation

Joint Advisory and Review Group (JARG)

• The consultation was robust and high quality

• All issues requiring further assurance had been referred to the National Clinical Advisory Team (NCAT) and assurance secured

• Nothing had arisen which required extension or reopening of consultation

JARG conclusions

• Implement the recommendations of the Travel Advisory Group (TAG) - future costs of the shuttle bus to be shared proportionately between the 2 CCGs

• Consider findings and recommendations from the deliberative event ( 2 July 2013)

• Take account of high levels of opposition– particularly in North Kirklees and reflect on the differences in views between North Kirklees and other residents

JARG recommendations

• Plan for continuous engagement of stakeholders (including patients/public) in implementing the proposals

• Communicate to raise awareness of the real implications of the Clinical Services Strategy

• The boards should assure themselves of the long term financial sustainability of the proposals

• The boards should weigh up the balance between public feedback, the clinical case for change and financial affordability

JARG recommendations (contd)

Pat Keane

Interim Programme Director

Meeting the Challenge

Recommended changes in response to feedback:• As many services as possible to be provided locally e.g.

outpatients. No patients should have to travel to a hospital further than their nearest one unless for clinical reasons.

• Paediatric assessment in Dewsbury to be available more hours per day and services for children with specialist needs to be developed.

• Also in Dewsbury: • local assessment to be developed• more post-operative care • Emergency Day Care Unit to be consultant-led inc. surgical

procedures and specialist assessment for frail, elderly.

Changes to original proposals/ambitions and conditions

Patient Choice

GP commissioning support

Clarifying clinical

evidence

Strengthened patient/public engagement

1. Agree that the paper is a formal record of the consultation and an aggregate of the major themes and that the process is robust and analysis is independent

2. Agree that the paper is the CCGs’ response to the consultation, taking into account the full range of views

3. Receive the independent report on the consultation and confirm that there has been robust consultation on the proposals in the Clinical Services Strategy

4. Agree that the process meets the Secretary of State’s four tests for service reconfiguration i.e. patient and public engagement, clarity on clinical evidence, consistency with patient choice and support from GP Commissioners

Recommendations

5. Note the issues highlighted by the public and agree the following amendments, subject to analysis of clinical and financial impact:

• As a default position, all outpatient appointments to be local unless for sound clinical reasons – this should start within agreed deadlines

• Paediatric Assessment Unit at Dewsbury Hospital to adjust its opening hours to accommodate demand

• Develop services for children, including those with complex needs, by enhancing specialist medical and community nursing in North Kirklees

Recommendations (contd)

• Develop urgent local assessment at Dewsbury Hospital for all patients who do not need admission to Pinderfields

• For planned surgery at Dewsbury, post-operative care to be developed so that more people can be treated locally

• Emergency Day Care Units to be consultant-led with consultants on site during the day. Opening times to be finalised after evaluation of the pilots. The units to include surgical procedures and specialist assessment for frail, elderly patients.

Recommendations (contd)

6. Approve recommendations from the JARG inc. support for the Travel Advisory Group recommendations i.e:

• Shuttle bus to be extended to cover mornings, seven days a week and to include a booking arrangement for disabled users (to be run as an initial pilot for one year)

• Commissioners to use Metro’s free tender service to source prices for a family and DDA compliant vehicle shuttle service

Recommendations (contd)

Mid Yorkshire Trust’s Travel & Transport Forum to oversee:• More flexible appointment times • Travel information with outpatient appointment letters• Better travel information at health premises• Support for patients arriving at hospital by ambulance to get home• A travel help line• Free Metro cards for Pinderfields A&E patients who can’t get home

any other way• Staff training on travel advice for appointments booked through GP

surgeries• Further investigations into a combined service for staff and visitors

Recommendations (contd)

7. Agree to progress transformation in the community through integration across health and social care

8. Approve the commissioners’ ambitions and conditions

set out in section 6. 9. Agree that the CCGs commission services that meet

the future needs of the population as described in the Clinical Services Strategy, as amended in recommendations 3.

Recommendations (contd)