APPENDIX 1

SOUTH TEES HEALTH SCRUTINY JOINT COMMITTEE

26 SEPTEMBER 2014

RESPONSE TO THE IMPROVE PROGRAMME PROPOSALS

PURPOSE OF THE REPORT

1.To present the South Tees Health Scrutiny Joint Committee’s response to the consultation in relation to the IMProVE proposals.

METHODS OF INVESTIGATION

2.Members of the Joint Committee met formally between 12 August 2013 and 17 September 2014 to discuss/receive evidence relating to these proposals and a detailed record of the topics discussed at those meetings are available from the Middlesbrough Council website.

3.A brief summary of the methods of investigation is outlined below:

(a)Detailed presentations by senior officers and members of the Governing Body from the South Tees Clinical Commissioning Group (CCG) supplemented by verbal evidence.

(b)Round table discussion with a wide range of organisations including Redcar and Cleveland Council, Middlesbrough Council, NHS England, Healthwatch, local MPs.

  1. The report has been compiled on the basis of their evidence and other background information listed at the end of the report.

MEMBERSHIP OF THE JOINT COMMITTEE

  1. The membership of the Joint Committee is as detailed below:

2013/14 – Middlesbrough - Councillors E Dryden (Chair), Councillor L Junier, (Vice-Chair), Chair), Biswas, Cole and Mrs H Pearson, Redcar & Cleveland - W Wall (Vice Chair), Ayre, Goddard, Thomson and Wilson

  1. 2014/15 – Redcar - Councillors Wall (Chair), Goddard (Vice Chair), Jeffries, Halton and Lanigan, Middlesbrough Councillors Dryden (Vice Chair), Biswas, Junier, Pearson and J Walker

SETTING THE SCENE

  1. NHS bodies or providers of NHS health services have a legal duty to consult about the way that the NHS is operating and about any proposed substantial developments or variations (or changes) in the provision of the health service in the area. Any ‘substantial’ variations or changes to NHS provision should be subject to formal consultation. Where a proposed substantial change covers more than one local authority area, legislation requires that the respective local authorities appoint a joint health scrutiny committee. In these instances, it is only the joint committee that will respond to the consultation; exercise the power to require information to be provided about the proposal and exercise the power to require members/employees of the relevant body to attend before it to answer questions in connection with the consultation.
  1. As the proposals covered facilities within Middlesbrough and Redcar & Cleveland Council the matter was dealt with through the South Tees Health Scrutiny Joint Committee.

BACKGROUND INFORMATION

  1. The Joint Committee began in August 2013 by receiving a briefing paper which outlined the pre-consultation process as part of the IMProVE programme and the Communications Plan that had been developed. Members had the opportunity to consider the plan and the questionnaire that had been designed and they made a number of comments as to the wording in the questionnaire and some suggestions for groups/organisations that the CCG may want to include in the consultation.
  1. The Joint Committee was informed about the proposals for how the CCG would engage with the public, it involved disseminating information to a wide range of agencies and public events would be held in numerous locations around the South Tees area.
  1. It was recognised by Members at an early stage that the opportunities being pursued, which included providing care outside of hospital in the community/GP practices and people’s homes, were likely to result in changes to the way community hospital beds were used.
  1. On 27 January 2014, members of the Joint Committee received the results of the Carers Together survey which had received 400 responses from the public. There was considerable support for care closer to home to assist with the patient’s recovery process and prolong independence, as long as there was confidence that appropriate good quality community based care services were in place.
  1. On 27 February the Joint Committee received an update on the proposed formal consultation process.
  1. In April, the Joint Committee was presented with the draft case for change, proposals for change were being put forward when the formal consultation started on 30 April and which would run until 31 July.
  1. At the meeting on 22 July, Members were presented with the Case for Change, which, in brief, outlined how 49% of patients in community beds did not have a medical need and would have been better supported by other services. That 33% of patients in an acute bed did not have an acute need. There were system wide financial pressures that needed to be addressed. The population is getting older, South Tees ranks as higher than the England average for almost all disease prevalence, both Local Authorities have higher admissions to residential care, an increasing number of unplanned admissions and a quarter of emergency admissions are from people aged 75 or over.
  1. The information at that meeting also outlined the model of care, the clinical review, the estate review, the workforce review, the accessibility travel plan and the phased approach. The phased approach would involve putting new services in place and testing them before moving existing services, making step by step decisions about the changes that are being made and the impact they have on patients and that the introduction of these changes will happen over the next 2 years with all services in place by April 2016.
  1. The Joint Committee was given a list of the community development work and re-investment that would take place between April 2014 and March 2016. Which would include, amongst other things, implementing the Community Stroke (Early Support Discharge) team, carrying out a resource review of therapy/capacity and demand, working with local authorities on reablement services, expansion of rapid response services, developing a Single Point of Access and Assessment Hub across the whole of the South Tees community and review current out-patient resource
  1. At the meeting on 17 September 2014 the South Tees CCG outlined the responses they had received during the consultation process.

VIEWS ON THE COMMUNICATION/CONSULTATION PROCESS

  1. Members were pleased to find that a large variety of communication/consultation mechanisms had been implemented as part of the process, including public meetings, road show events across Middlesbrough and Redcar and Cleveland. Other mediums had also been used to raise awareness and encourage participation in the process. The Joint Committee welcomed the opportunity to be involved in the early development of the consultation proposals.
  1. The Joint Committee had made a number of suggestions about ensuring work was undertaken in order to reach the elderly, the housebound and people with long term conditions.
  1. The Joint Committee heard that the consultation process had been independently verified and a mid-stage review had been undertaken by Healthwatch. Healthwatch had confirmed that throughout the consultation with their networks they had not received any negative comments or any major concerns from the public.
  1. In general the Joint Committee was supportive of the consultation process that had been undertaken by the CCG. Members had the opportunity to contribute to the questionnaire and suggest people/organisations the CCG should include in their consultation.
  1. Details of the proposals were outlined in the consultation document, however there was a concern that if someone had not read the proposals document thoroughly or went straight to the questionnaire, it was thought that people would tend to agree with some of the questions, for example the question ‘Do you think we should centralise stroke rehabilitation services in a single specialist unit in line with best practice?’ people could answer yes without realising that would mean that they would now have to travel to Redcar.
  1. Dave Walsh, representing Tom Blenkinsop MP, made a number of comments regarding the consultation and the proposals which included, amongst others, the following
  • Concern about the consultation process, for example some people in the Brotton area had received details very close to the end of the consultation period. It was noted that the questionnaire could have been seen as leading people in to certain responses and that the implications of the proposals weren’t as explicit as they could have been.
  • Concerns about re-provision of service through GPs when practices like Skelton walk in centre and Park End have closed and other practices like those in North Ormesby and Hemlington are being reviewed.
  • Variable public transport between Guisborough, East Cleveland and Redcar
  • No formal consultation with the Royal College of Nursing, Local Medical Council and unions.
  1. The CCG agreed to take note of the above comments and work through them separately.

RESPONSE TO THE CONSULTATION

  1. The Joint Committee heard that 586 survey responses had been analysed, 24 direction observations had been taken from events and responses had been noted from key stakeholders. Information from the consultation had ‘chimed’ with the results of the pre-consultation. The results were largely positive and where a mixed response had been received respondents had been mainly concerned about transport, waiting times and capacity
  1. The Joint Committee noted the consultation feedback which indicated that the significant majority of those responding to the consultation were in support of the proposals.

Transport

  1. Transport was highlighted as an issue where people who had responded to the consultation had some concerns. When asked about whether community beds should be provided in 2 locations within the South Tees Area 15% of people were concerned about travel issues. 31% of people had concerns about travel and transport when asked about the proposal to provide a more comprehensive minor injury service in a single location (i.e. Redcar Primary Care Hospital). In discussing the proposed closure of the Minor Injuries Unit in Brotton there was a concern that people would not be able to access alternative services using public transport. The Joint Committee heard that there was no bus service to Redcar from the Guisborough area after 6pm. The CCG confirmed that they were taking this issue on board. There was a concern amongst the Joint Committee that people would then present to James Cook University Hospital (JCUH) however the clinical view presented at the meeting outlined that the bed base in Brotton Hospital will stay, services and diagnostic facilities would increase and that patients from Redcar/East Cleveland would go to Redcar Primary Care Hospital and not JCUH.
  1. Members discussed the patient transport service that is available, it was noted by the CCG that the service was seen as a model for the North East, although members of the Joint Committee, with experience of the service, believed that the criteria for a person to qualify to access the service was too long, the process of a person having to answer a lengthy set of questions prior to being accepted for the service was too bureaucratic and this led to people being deterred from using the service.
  1. Ian Swales MP called for a radical look at public transport, this was echoed by the Joint Committee who wanted to ensure that any changes would involve consideration as to how people who did not have their own transport could access the different services. It was noted that Redcar Primary Care Hospital could be a difficult place to get to even for people in Redcar area.

Bringing Care Closer to Home

  1. It was noted that 96% of people agreed with the aim of improving prevention and delivering more care in the community. However, with regard to bringing care closer to home, people who completed the survey were concerned about the robustness of care plans, and people wanted reassurance that social care and health care services would be effectively joined up and that there would be the right level of trained professionals able to provide the service. The Joint Committee was reassured by the CCG that beds would not be removed until the CCG could demonstrate that the services were in place in order to cope with the changes.

Financial Viability

  1. The Joint Committee was also concerned that the plans were financially viable. Whilst agreeing with the view that it was preferable that £2m was not used to fund void spaces in hospitals, and that it would be more effectively used for funding services in the community, Members stated that the right community services needed to be in the right place in place before any bed numbers were reduced.
  1. The Joint Committee also welcomed the proposed community development and re-investment which would take place between April 2014 and March 2016 which included the recruitment of additional staff and ongoing appropriate training of current staff.
  1. However there were concerns amongst Members that that there could be a ‘chicken and egg’ situation, in that facilities couldn’t be closed until new and improved community facilities were in place, but there was a concern that those facilities couldn’t be put in place until money was saved from the rationalisation of the buildings.
  1. In discussing the issues above the CCG gave assurances that no community beds would be removed until the right community services were in place. The CCG had also told the committee (in the meeting on 22 July) that changes will be made in a phased way, putting new services in place and testing them before moving existing services, making step by step decisions about the changes that are being made and the impact that they have on patients and their health before continuing to the next step. Proposals will be introduced over the next two years with all services in place by April 2016. The committee were given a brief timetable for when the changes would take place which was as follows:

Development of community services which focus on improving pathways of care and discharge processes.
Implement a community stroke team, increase reablement, rapid response and therapy services.
Implement a single point of access and implement an assessment hub / April 14 – March 16
Centralise stroke rehabilitation services to one specialist unit (Redcar Primary Care Hospital)
Closure of Carter Bequest Hospital and re-provision of services within the community.
Consolidation and enhancement of Minor Injuries services onto one single site (Redcar Primary Care Hospital) / By April 2015
Redevelopment of Guisborough Primary Care Hospital (Chaloner Building) to provide increased range of community based services, closure of community bed base in Guisborough. / April 2015 – March 2016
  1. The committee will be following the development of the proposals closely and will expect to receive periodic updates on its implementation.

The Right Thing for People in Redcar and Cleveland and Middlesbrough

  1. Whilst the Joint Committee was broadly supportive of the improvements to community services, Members had questions about how the proposals would work in practice. Members agreed that the aspirations behind the proposals were good. Where Members felt that they needed more discussion and clarification was about whether the changes were in the best interests of the public. Members explored this issue in further detail with the clinicians present at the meeting in order to get beneath the detail on how the proposals would make improvements. The clinicians outlined how the proposals would improve services from a clinical perspective. For example, Members heard that prevention was a key factor, with regard to chronic conditions there was a need to prevent admissions and if people did have to go in to hospital it was important to ensure that they were discharged with adequate support at the right time and to ensure that people can maintain their independence in their own homes.
  1. For patients with Chronic Obstructive Pulmonary Disease (COPD) Members heard that it is in the best interests of the patient to get them home with the right support in place for them. They learnt of an initiative where community matrons have been put in place which had received excellent patient feedback.
  1. In further exploring why these proposed changes were the best for people in the South Tees area it was outlined to the Joint Committee that the clinical view was that this was the best way forward. For example, stroke services were not currently meeting best practice. As Members had heard previously there were areas that needed to be improved in line with that best practice.
  1. The South Tees lagged behind other areas in the support that was offered to people to enable them to return home quickly, which aided a speedier recovery. The Stroke services that would be re-provided away from Carter Bequest and in Redcar Primary Care Hospital would be ‘second to none’. They will meet national best practice and ultimately provide better outcomes, better intervention and deliver a service that people presently do not receive. Members heard that a community stroke team was already being developed for people in the South Tees area.
  1. The consultation document outlines brief proposals of how the CCG will meet national best practice guidelines by centralising all stroke rehabilitation and supporting services, e.g. physiotherapy, occupational therapy and dietetics at Redcar Primary Care Hospital. This will include 12 dedicated beds for stroke rehabilitation. The committee will have a keen interest in seeing how those services will develop
  1. There was a concern that the proposals had been developed as a ‘basket’ of measures designed to sustain Redcar Primary Care Hospital (a PFI Initiative). Whilst the CCG did not rebuff this suggestion, they explained that they had inherited the community hospitals and along with that the 35 year PFI lease. Ultimately the proposals were about quality, accessibility and affordability. The model of care that was developed had been the driver for change along with clinicians coming together with acute colleagues to develop the best model of care.

Staffing