Tuesday 20th January 2015
Capesthorne Room, MacclesfieldTown Hall
Attendees NameTrevor Lerman / TL / Chair and Handforth Health Centre PPG
Andrew Blain / AB / Kenmore PPG
Barrie Towse / BT / Macclesfield Resident
Charlotte Peters-Rock / CP / Deputy Chair and Cheshire Area for Cheshire Action
Chris Campbell-Kelly / CC / Practice Manager Park Lane Surgery
Cyril Towse / CT / Macclesfield Resident
Debbie Jamison / DJ / Knutsford Resident
Diane Walton / DW / VISYON
Eileen Talbot / ET / Senior Voice for Macclesfield
Gill Barber / GB / Senior Voice for Macclesfield
JacquieGrinham / JG / CitizensAdviceBureau(CAB)
Jo Hawkins / JHa / The Alzheimer’s Society Support Service Manager
Jo Rose / JR / Annandale PPG
Milka Podsiedlik / MP / Pathways CIC
Tony Firth / TF / Holmes Chapel PPG Chair
In Attendance
ECCCG
Alex Mitchell / AM / Chief Finance Officer
Andrew Binnie / ABi / Quality & Performance Manager
Charles Makin / CM / Communications Manager
Dawn Wayne / DaW / Notetaker
Jacki Wilkes / JW / Associate Director of Commissioning
Jerry Hawker / JH / Chief Officer
Karen Burton / KB / Clinical Projects Manager
Lana Davidson / LD / Senior Contracts Manager
Neil Evans / NE / Commissioning Director
RebeccaPatel / RP / Public Engagement Manager
Sally Larvin / SL / Contracts Manager
Other
Hadrian Collier / HC / Patient Transport Services
Item / Actions
Welcomeandintroductions
TheChair (TL)welcomedthegroup.
Minutes of the last meeting
The minutes of the meeting held on 21st November 2014 were accepted as an accurate record.
Matters Arising
TL wished the group to note the following:
HealthVoice Subgroups
All the subgroups met in early December but no further meetings have taken place due to the Christmas break and illness, therefore there was no further progress to report.
Engagement of Practice Managers
The item relating to the ECCCG Chair, Paul Bowen, taking the requirement for more pro-active engagement of some of the Practice Managers with their PPGs to Locality meeting was still outstanding and TL would continue to request assistance from the CCG with this.
Action: TL to contact PB again on behalf of HealthVoice members / TL/PB
Current Performance of MacclesfieldDistrictGeneralHospital (MDGH)
Jacki Wilkes (JW) and Andrew Binnie (ABi) gave a presentation to the group (attached) which showed the current performance of MDGH in the target areas of: Emergency Care 4 hour wait, 18 Week Referral to Treatment waits and North West Ambulance Service response.
JW advised that the System Resilience Group which has been re-scoped and rebadged from last year’s Urgent Care Working Group now had a much wider remit to cover elective care as well as urgent care and was working very hard to find ways to help the Trust cope with the nationwide unprecedented rise in emergency activity. The Group was informed that the target of a 4 hour maximum wait in the Emergency department at the hospital would be very unlikely to be met for this quarter, unlike last year where the Trust was one of the few in the country who were able to meet target. The System Resilience Group was working with the hospital get as close as possible to the target.
A question was raised about whether all elderly patients who are admitted to the hospital have attended the Emergency Department. JW replied that most were but some are admitted directly throughthe Acute Assessment Unit. Latterly this unit has been utilised to take overspill from the Emergency Department as most patients were too ill to be moved to Intermediate Care beds. JW also added that, following the success of regular GP visits to nursing homes, it was hoped that a similar scheme could be adopted for residential homes which would also help to alleviate the pressure on the Emergency Department by identifying potential illness in the elderly before it becomes serious. The number of beds in the hospital would be increased by approximately 15% to cover the winter crisis, partly by converting elective surgery beds to non-elective but this has a knock-on effect for the targets for elective surgery. The hospital also has plans to convert day beds and to re-open closed beds following a recent recruitment campaign for extra staff.
A question was asked about whether there was a case for re-opening the intermediate care beds in Knutsford hospital to help release beds being blocked at MDGH. JW advised that in most cases the patients were too ill to be moved to intermediate care beds or would have a better outcome if they were cared for in a community setting rather than in a hospital.
JW also stated that the System Resilience Group had engaged a subgroup to look at where improvements can be made to delayed transfers of care and they had also commissioned a “green car” using winter pressures funding, which would assess non-urgent cases, freeing up ambulance crews and avoiding subsequent transfers to the Emergency department.
A question was raised as to whether the delay in completing assessments had had an effect on availability of hospital beds and what initiatives were being taken to address this? JW responded that some community staff had been brought in to help do the assessments but as they were needed in the community too, this was unsustainable. Some recruitment had taken place to ease the backlog and staff from the Discharge Liaison Team had also been drafted in to try and cope with the very high demand for these assessments.
Patient Transport Services
Hadrian Collier, Ambulance Commissioner for non-emergency patient transport services for the North West addressed the group. He advised that currently there were two providers of non-emergency patient transport in the North West, North West Ambulance Services and Arriva Transport solutions. The current contract for non-emergency patient transport, which expires in March 2016, had previously been drawn up with the old Primary Care Trusts and were only commissioned for three years to cover the emergence of the Clinical Commissioning Groups.
The group was asked to feedback to Hadrian on a number of issues via questionnaire (attached) or verbally within the next two months to enable the tender documents to be drawn up and the Invitation To Tender (ITT) to be sent out this Summer.
Action: RP to send round questionnaire for comments back to Hadrian asap.
(Update: details below were circulated on 21.1.15)
/ RP
Budgets & Funding
Alex Mitchell, Chief Finance Officer at the CCG, tabled a document (attached) detailing the ECCCG Financial Summary to 31 October 2014, including types of income received, planned spend and pressures. The total amount of funding available for Eastern Cheshire CCG for 2014/15 was £230m. AM advised that funding targets for CCGs had been increased but the increase would be shown over a number of years, every CCG had received an uplift of 2.14% for 2014/15 but this is still below target. The final budget figure for 2014/15 shows a £2m deficit. This figure has been agreed with NHS England and reflects the longer term vision for integrated care within Eastern Cheshire. Some funds will be clawed back through Continuing Healthcare Restitutions etc. and it is expected that CCGs who are furthest away from their final funding targets will receive additional reworked uplifts for next year. It is anticipated that the average uplift for CCGs will be 1.94% but for ECCCG it will be nearer to 5.8%. The additional system resilience funding is included in this figure but overall it will move us nearer to our target figure.
Commissioning Contracts Position
Lana Davidson, Senior Contracts Manager for the CCG, updated the group on key facts around current commissioning contracts and where the expenditure goes.
-Total projected spend for 14/15 for the CCG is £230 million
-Of this amount, £158million is assigned to “contracting” to commission urgent, planned, community and Mental health services etc.
-£13.5 million is spent on Continuing Health Care with a further £5.2 million being spent on nursing support in care homes. This is a combined total of over 8% of the total CCG budget
-A further £2.1million is spent on Primary Care schemes such as minor surgery – this lessens the pressure on acute providers
-Of the £158million contracting budget, a little over 4% (£7 million) is spent on private/commercial providers who provide planned care in accordance with the national tariff
-All private providers operate on a cost and volume basis – ie patient choice is the main driver for demand with these providers
-As patients become more aware of the presence of private providers, demand has increased and private providers have helped to meet this demand – growth between 13/14 and 14/15 is currently 17%
%
Hospice care / 0.29%
Local Authority / 0.23%
NHS / 94.73%
Optometrists / 0.00%
Private providers** / 4.44%
Voluntary / 0.30%
-During 14/15 we led 2 competitive tenders for ultrasounds and Wet Age-related Macular Degeneration (WAMD). Both were awarded to a combination of private and NHS providers
-In 15/16 it is expected that we may tender for Ophthalmology services due to a shortage in capacity and Termination of pregnancies services in order to comply with EU regulations.
** It should be noted that Private Providers include GP Practices, Opthalmologists, Pharmacies, Dentists,etc, but not all private providers are profit-led organisations, i.e. Vernova Healthcare.
A comment was made regarding the timing of ECCCG’s consultation/procurement process as recent contracts did not seem to have involved HealthVoice members at an early enough stage and it was in danger of becoming a ‘talking shop’ with no influence over decisions. TL stated that representatives from HealthVoice werenowregularly involved in the commissioning intentions process and work was ongoing to work more closely with the CCG from a much earlier stage in the process.
Jerry Hawker advised that engagement with the public of Eastern Cheshire was vital, be it during the consultation or procurement process. If the CCG wants to change the way services are provided it has to go out to consultation and if a number of providers are able to provide that service the CCG has to abide by EU Procurement Law and undertake a proper procurement process as in the case of WAMD. With regard to re-commissioning stroke services, this was driven by changes in the NICE guidance and clinical need. No procurement process was undertaken as there was only a limited source of provision for the clinical services required. The CCG were striving for continuous improvement and part of our engagement with the public is learning about what is successful and which areas need further attention.
RP advised that HealthVoice was only one of the engagement processes used by the CCG and there is a need to strengthen the involvement of all groups of people within Eastern Cheshire. Considerable work had been and is continuing to be done involve young people and a subgroup of HealthVoice will work on inclusion and involvement with minority groups.
Provision of Diabetes Education
A short presentation was made to the group by Karen Burton to give an update on the commissioning of an evidence based structured education programme for people with diabetes. One of the 15 essential standards that Diabetes UK recommends is that diabetics attend an education course. A project group has been set up which has pulled together all the health needs information and has consulted national guidance documentation. The outcome of the service will be to improve the knowledge and skills of patients with diabetes. Two options are currently being worked into a business case:
- To develop a local service, using skills and expertise within our GP practices - which may take practitioners away from their normal role
- To procure a service from the wider market
Action: DJ, JR and JH to discuss outside the meeting and report back
DW enquired whether the Expert Patient Programme was still in existence. It was advised that the EPP was now run from Cheshire & Wirral Partnership Trust.
Action: RP to circulate details of the Expert Patient Programme to the group.
(Update – details below were circulated on 21.1.15)
Expert Patient Programme
/ DJ/JR/
JH
RP
Any Other Business
ET complimented the CCG on the recent health-related articles which appeared in the Macclesfield and Wilmslow Express. CM advised that we are endeavouring to include similar columns in the Congleton Chronicle and Knutsford Guardian in the near future. CPR noted that similar publicity would be useful to promote the existence of HealthVoice and TL advised that this would be considered along with other promotion and marketing ideas when the Marketing and Communications sub-group next convened.
Date and time of next meeting
Friday 6th March, 10.00-12.00 Disley Community Centre, 19 Buxton Old Road, StockportSK12 2BB
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Eastern Cheshire HealthVoice Minutes January 2015