Bromley – Q&A from Healthwatch
QWhy are adult day centres in Bromley closing? The demographic in the borough clearly indicates a need for such services. Referral numbers for these services are down, so where are these people going and how are their needs being met?
A: The council has not stopped funding day services for the elderly.What has changed is the way that day centres are funded. Over recent years there has been a national move towards personal budgets and direct payments that enable people to choose how they wish to use their funding and this has in some cases resulted in fewer people attending day centres. For example, some people have opted to use their funding to purchase the services of a personal assistant and have chosen to attend local groups or other activities within the community.
The Council does believe that day centres play an important role in supporting local people and recognise that the opportunity of choosing to attend a day centre in the Borough is an important option for some of LBB’s older residents. As such the Council has encouraged and where possible supported centres to grow their business, for example, by promoting day services to those residents that are not in receipt of social care funding in addition to continuing to accept a number of placements funded by the Council. Some day centres have been creative in attracting such additional funding to ensure that they remain sustainable into the future, which is something that the Council would like to see pursued more widely.
Q: Will there be a young people support drop in Biggin Hill, Beckenham Orpington
A: We would need more information to answer this fully, however, there are existing Children’s Centres. Youth Hubs as well as the leaving care hubs available in these areas. Please contact the local authority if further information is required.
STP – general
Q:How will the STP ensure that care is consistent across locations and services in south east London?
A:It is the role of the STP to co-ordinate and align plans across the communities which make up the STP. At the same time, provision and management of services in each area continues to be the responsibility of local Clinical Commissioning Groups.
Q:Could you further explain the working relationship between the STP, the local authority and the voluntary sector?
A: The STP is a partnership of which local authorities are represented in its formal governance arrangements. The relationships are strong which is vital if we are to tackle some of the challenges and make integration between different parts of the health and care system more effective. We recognise the role of the voluntary sector and are examining how we can do more to make sure voluntary partners in the six boroughs are able to contribute more to the STP.
Q: How will services be coordinated across the boroughs?
A greater emphasis needs to be placed on recycling NHS resources, for example hearing aids, and more emphasis on less expensive and costly treatments. Can you further explain how NHS resources are being utilised in the STP?
Provision across services and locations is patchy and inconsistent – will this be rectified by the STP?
A: OHSEL doesn’t have a budget or a formal co-ordination role but helps make sure the operational plans of individual hospitals and other providers in SEL are aligned and co-ordinated to get the best services available with the money we have.
There are changes we can make together which improves how we deliver care, and saves money.
Examples:
- Reducing hospital admissions by spending more on primary care
- Sharing some administrative back office functions
- Focus on prevention and early intervention
The STP, together with its partners, is working on making services more consistent. A good example of this is what we are doing to improve non emergency orthopaedic services.
Because there are inconsistencies in the service, and areas where we are not meeting expected levels of efficiency and quality, we have agreed that we will create an Orthopaedic Clinical Network, led by our three provider trusts, to oversee the delivery of the quality and efficiency benefits set out in Professor Tim Briggs’ Getting it Right First Time (GiRFT) report over our three main elective sites.
The network will be appropriately resourced and a Clinical Director will be appointed by the STP.
Privatisation and procurement
Q:How much money is going to be spent on “outsourced” agencies to make these changes? E.g. Capita or Virgin Money
I’m concerned about privatisation in a similar way that we privatised rail – allowing foreign governments to profit from our railway or giving Richard Branson huge subsidies. What role does privatisation take and what does ‘partners’ really mean e.g. my Mum had both hips replaced by the same surgeon in the hospital, one paid privately and one on the NHS, how is that really working?
What cuts are happening in the area? Will there be any closures? If so, will there be alternative provision? Will services be privatised?
A:There is nothing in the STP programme which is about privatisation. Similarly there is nothing in the STP which closes services.
Voluntary sector
Q:Is there an expected increase of voluntary workers, as a result of reduced money in the NHS?
A: We value the role of voluntary workers in the NHS but, if we understand the premise of this question, there is no question that they would replace existing NHS staff.
Changes or closures to local services
Q:In south east London do you anticipate any A&E closures or downgrading of services at hospitals?
A:There are no proposals as part of the STP to close or downgrade services. We plan more focus on primary and community care to help us cope with rising demand for our services.
Q: There are already limited resources for autistic services in the borough, does this mean there is an additional threat to services at the Phoenix Centre?
A: There are no current plans to change the offer to children and families living with autism. The services delivered at the Phoenix Centre remain essential to our plans to ensure that all children living with ASD can have their health needs met in an appropriate place.
The CCG has invested additional resources to reduce waiting times for autism diagnosis in Bromley, and families can now access additional pre-and post-diagnostic services through Bromley Mencap.
Q:Will podiatry services remain the same in Bromley and how do people access them?
A: Bromley Healthcare (BHC) provides community podiatry services. Services have recently been improved following feedback from patients and more appointments are now available and waiting lists are shorter.Information about the service is available on the BHC website at or you can call 020 8315 8715. The service provides a broad range of foot treatments, advice and specialist services including wound management, diabetic management, foot care for children, biomechanics and orthotics. Patients can refer themselves to the service.
Q: What are the changes are happening in relation to the OTC medication? Do these new restrictions apply to vulnerable patients and those with LD? Some patients need careful monitoring and care to prevent causing harm to themselves and unnecessary cost to the NHS if their health reaches crisis point.
A: The CCG is currently engaging with local people on proposals to no longer support the routine prescribing of medicines available to buy over the counter to care for short lived illnesses which get better over time. This engagement runs from 31 July to 8 October. Not everyone will be affected by the proposals – for example those patients with long term conditions and complex health needs would continue to have these medicines prescribed on the NHS.
Q: Will community provision improve, for example the community physiotherapist service? How will patients access it?
A: Following the re-procurement of community health services this year, a number of improvements will be made to the provision of general community health services including shorter waiting times, improved access, extended opening times, more focus on prevention and more services provided from local settings.
In relation to community physio services – adult services are currently provided by Crystal Palace Physio Group until March 2018. The CCG is in the process of re-procuring this service and will be seeking to make improvements to access including enabling patients to self-refer. Patients can currently access the community physio service through a referral from their GP.
Communications
Q:Are there plans for accessible formats for all future patient correspondence, e.g. appointment letters and medical information? (from the Kent Association for the Blind)
A:Health and social care providers are legally required to follow the Accessible Information Standard which sets out a specific, consistent approach to identifying, recording, flagging, sharing and meeting the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss. We are working with local health providers to make sure that information is available in different formats and different languages for people who require it. It is recommended that any requests for information in different formats are made directly to the provider of care.
Q: How can local people stay updated on changes locally and to services that matter to them?
A: The CCG website provides information about local services and the Our Healthier south east London website provides the bigger picture of what is happening across south east London. CCG publishes a quarterly bulletin providing an update on what is going on in local services and this can be emailed directly to people. More information is available on the CCG website or call 01689 866544. You can also find out information through your local Healthwatch or consider joining the CCG’s Patient Advisory Group which enables you to be directly involved in the work of the CCG and influence any developments or changes.
Aside from existing local CCG arrangements for communication, we would encourage anyone who is interested in receiving regular updates on OHSEL, to contact us at
Q: What community provision is available for people post-op, who are recovering in their homes?
A: A range of community health services are available to people who are recovering at home following surgery. On discharge from hospital, the right community support is put in place which is provided either by the patient’s GP or the relevant community service such as district nursing, falls team, physio therapy etc. In addition, the Transfer of Care Bureau based at the Princess Royal University Hospital is made up of discharge staff working across different services in Bromley who have been brought together to aid the safe discharge of our most vulnerable patients.Before a patient is fully discharged, the appropriate care package is put in place to enable them to recover fully in the community.
Patient choice
Q:Will patients be offered equal opportunities with regards to potential treatment and surgery? Patient choice is very important and patients need to be aware of their options, as well as being able to access the same treatment at different centres.
A: Patients will be treated equally according to their need within Bromley. We also must make sure services and treatments are cost effective and in line with good use of NHS resources. The CCG acknowledges its duty to enable patients to make choices, and to promote their involvement in decisions related to their care. We support patient choice and work closely with GPs to ensure patients are aware of their options when being referred. We have a Treatment Access Policy which provides a consistent approach to agreeing funding for certain procedures and treatments. Patients who need treatment are advised on lifestyle changes (if needed) to maximise success of any surgery or other treatment.
Support for vulnerable people
Q:How will vulnerable adults be supported in the system going forward? There are increasing levels of dementia and social isolation and many still remain unaware of local support options. How will the STP support and help these people? What will be available locally?
A:Our most vulnerable adults, especially those with complex health needs are benefiting from our new integrated care network model of care. These patients are identified by their GP and are then assessed by a community matron in their own home. A multi-disciplinary team of health, social care and voluntary sector staff work together in a joined up way to meet the immediate individual needs of each patient and support them to keep well and out of hospital. A new social prescribing scheme delivered through this model of care, enables patients to be referred to a range of voluntary led schemes which can support them to live more fully and independently in their local community.
Over the last year, the CCG has invested in more care for people with mental health conditions to enable them to either manage or live well with their condition, or to recover. This includes a new specialist community perinatal mental health service for pregnant women, a Dementia Support Hub which is supporting people and their families diagnosed with dementia, a Recovery Works helping people get back into education or employment and a new extended access psychological therapy service.