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Board Meeting of the Governing Bodies Ossett Town Hall 25 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. - PowerPoint PPT Presentation
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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 KeaneInterim Programme Director
Meeting 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 areaArea Wakefield North
KirkleesLeeds
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
TransportThe 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 & EngagementMeeting 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 DirectorMeeting 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)