Calderdale CCG and Greater Huddersfield CCG Governing Bodies meeting - - PowerPoint PPT Presentation

Findings from consultation and deliberation and next steps Calderdale CCG and Greater Huddersfield CCG Governing Bodies meeting in parallel

• Background
• Deliberation
• Purpose
• What we considered
• Findings
• Full Business Case
• Recommendation

Introduction

The Governing Bodies have agreed

• No change is not an option
• To adopt a phased approach
• The Clinical Model of Care
• Appraisal criteria
• Significant financial implications
• Clear mandate for consultation
• Sufficient change to consult on Phase 2
• Consult on Ph2 and Ph3 at same time

Background

Background

• The Consultation has finished
• Received
• Report of Findings
• Equality & Health Inequalities

Impact Assessment

• Joint Health Scrutiny Response
• Healthwatch Response
• Consultation Institute sign off

• Purpose & Context
• What we considered
• Report of Findings & Stakeholder Event
• Equality and Health Inequality
• Joint Health Scrutiny & Healthwatch
• NHS England Assurance
• Recommendations from deliberation

Deliberation

Deliberation Purpose To enable the CCGs to:

• give proper consideration to the

response to the public consultation

• discharge their duties and
• bligations, including those in

relation to Equalities and Health Inequalities

Deliberation Context

• Consultation mandate
• CCGs’ Patient Eng & Exp Strategy
• NHS Act 2006
• Gunning Criteria
• The Equality Act 2010
• The Brown Principles
• Health and Social Care Act 2012

Consultation Mandate

Sets out:

• 1. Purpose of Consultation
• 2. Parameters of Consultation
• 3. How people will influence the

proposals

• 4. How the findings will be

considered

Independent Report

• f Findings
• Considered:
• 7582 Surveys
• 40,000 comments to 11 open questions
• 500+ phone calls, letters, docs, texts &

emails

• 195 pages of transcripts – 3 public meetings
• 10 vox pox
• 8 petitions

Question 10 Do you think you will be negatively affected by our proposed changes? Yes % No % Don’t Know % Greater Huddersfield 80 12 7 Calderdale 33 47 20 Overall 67% of all respondents stated they would be negatively affected by the proposed changes

What did people tell us

Question 12 Overall after reading the document do you agree or disagree with our proposed changes? Agree % Disagree % Neither Agreed or disagreed % Greater Huddersfield 7 79 11 Calderdale 47 28 22 Overall 64% of all respondents said they disagreed with the proposals

What did people tell us

What did people tell us Six Focus Areas

• Travel and Transport
• Clinical Safety and Capacity
• The rationale for change
• The consultation process
• Understanding the proposed model
• The need for change

What did people tell us Travel and Transport

• Increased time in an Emergency
• Congestion on A629
• Public Transport – Access and Cost
• Parking at CRH
• Demand on the Ambulance Service

What did people tell us Clinical Safety

• Impact of travel on mortality
• How will it work in practice
• Mainly Urgent/Emergency

relationship Capacity

• Beds, Staff & impact on other areas

What did people tell us The Rationale for Change

• Driven by finance
• Influenced by the PFI
• How will it be funded
• Value for Money
• Support from clinical staff

What did people tell us The Consultation Process

• Single Option
• Language and clarity of material
• How was option developed & what

evidence

• From Staff – want to be involved

What did people tell us Understanding the proposed model

• Possibly not fully understood
• How it will work in practice
• Emergency Care in both towns
• Understanding of terms:
• Emergency Care
• Urgent Care

What did people tell us The need for change

• Acknowledge the need for change
• Alternatives & Improvements
• Configuration
• Services
• Proposals overall
• Existing structure unsustainable

What did people tell us Service Areas

• Emergency Care
• Urgent Care
• Planned Care
• Maternity Services
• Paediatric Care
• Community services

What did people tell us Emergency Care

• Travel times and Access
• Resources, Staffing and Demand
• Mortality and Waiting times
• Keep Emergency in Huddersfield
• Bed Capacity
• Consultation Process

What did people tell us Urgent Care

• Location less of a concern
• How will it work in practice
• Confidence in NHS111
• GP Capacity
• Staff levels and skills
• Access to right staff and care

What did people tell us Planned Care

• Fewer concerns
• Calderdale more in favour
• Travel
• What if Emergency Care is needed
• How will proposals be funded

What did people tell us Maternity services

• Provision in Community
• Patient Experience of care
• Understaffing
• Personal Care budgets
• Privatisation

What did people tell us Paediatric Care

• Speed of treatment
• Ability to travel
• Confidence in NHS111
• GP Capacity
• Staff levels and skills
• Waiting times and Access

What did people tell us Community services

• Access and Waiting times
• GP Capacity
• Staffing
• Finance – cuts in community

Stakeholder Event Findings Summary:

• 1. Acknowledge people’s contribution to the

consultation

• 2. Clarify for people why the proposals have been

put forward

• 3. Inform people about what is being proposed
• 4. Establish more detailed information about how

the proposals could work Full Report published on the Right Care website

Equality and Health Inequalities Impact Assessment - considerations

Equality

• The Equality Act 2010
• The CCGs’ Equality Strategies
• The public sector equality duty
• the Brown Principles;

Health Inequalities

• The NHS Constitution
• The NHS Act 2006

Equality and Health Inequalities

• ensure that the proposals would not have

any unlawful consequences for people who live or work in our communities.

• Consultation
• Prior -

Equality Impact Assessment

• During - Regular review
• Post -

Equality and Health Inequalities Impact Assessment (EHIIA)

• Continuing Duty

• Nothing found amounting to unlawful discrimination
• The proposals are intended to help improve access,

experience and outcomes for all

• Could have a significant positive impact on health

inequalities for children and young people and those who experience disadvantage by improved access to more services in the community.

EHIIA Findings

• Travel and transport are major issues.

Mitigations include: communication; further work with key partners; road network improvements ; and addressing parking issues.

• Changes to services can be upsetting and/or confusing.

Mitigations include: targeted communication; and service change in relation to accessibility.

• Proposals and their feasibility may not be well understood.

Mitigations include: strengthening communication regarding the rationale

• Ongoing review during implementation.

EHIIA Findings

Potential differential Impact

• Under-represented Groups

– Engage in development and implementation of any future service change

• Accident and Emergency Service usage

– understand if this would be Urgent or Emergency Care. – Address through ongoing review during any implementation.

• Maternity Service usage

– The proposed changes enhance existing services.

EHIIA Findings

Joint Health and Overview Scrutiny Committee (JHOSC)

Formal response: 19 recommendations grouped into 9 areas Two (9 and 10) for specific consideration:

• Explain Urgent Care
• Further Clinical Senate review

Healthwatch – Submitted to JHOSC

NHS England assurance process To satisfy the NHSE change assurance process, service change proposals are expected to comply with the DH four key tests for service change;

• Strong public and patient engagement
• Consistency with current and prospective

need for patient choice

• A clear clinical evidence base
• Support for proposals from commissioners

NHS England assurance process (cont) Prior to consultation - three further work areas;

• 1. Requirement for capital funding will require

input from Monitor and DH

• 2. Need to assess the impact of the Cumberledge

review when available

• 3. Need to continue to engage with the wider

health system as the WY U &EC network plans and STP are developed

Four key tests

• 1. Strong public and patient engagement;
• Fulfilled the requirements of the TCI Quality

Assurance Process - consistent with their good practice standards.

• High level of engagement with the consultation
• 2. Consistency with current and prospective need for

patient choice;

• Would provide broadly similar levels of choice in

relation to the provider(s) of services.

• EHIIA concluded that ‘no indication was found of the

proposed changes being discriminatory’

• Mitigating actions identified

Four Key tests (cont…)

• 3. A clear clinical evidence base:
• Model and Standards
• Model in line with national guidance & standards
• Model and standards assured by YH Clinical Senate.
• Commissioners have identified some concerns:
• Capacity (beds, community services, Gen Practice)
• Planning permission and capacity at CRH
• Develop as part of a Full Business Case.
• The Kirklees LMC
• Concerns consistent with commissioners’ position.
• If proceed – work with them to address

Four Key tests (cont…)

• 4. Support for proposals from clinical

commissioners

• This report provides clinical commissioners

with the findings from the post consultation deliberation phase. Continued support for these proposals from Clinical Commissioners will be decided at the meeting.

Deliberation Recommendations

Emergency Care

• Travel and transport Group
• Update Travel Analysis
• Develop detail on workforce and estates
• Implications for commissioning Ambulance Services

Urgent Care

• Progress the urgent care proposals.
• Further work on Feasibility and affordability
• Develop the Staffing model and detailed Workforce plans

Care Closer to Home

• Continue to develop and improve Care Closer to Home.
• Provide more therapies and services in the community.
• Start now - services that can be provided out of hospital

Maternity Care

• Hospital based maternity model stays the same.
• Improve current service – consultation and CQC report
• Identify the expansion of community provision in line with

the national maternity review. Planned Care

• Progress changes taking into account surgical consultant

feedback.

• Ensure risk assessments and escalation policies and

procedures are in place.

• Set up a travel and transport group
• Further clarity and information on rationale and proposals

Deliberation Recommendations

Paediatric Care

• Progress the paediatric proposals
• Develop detail in relation to children’s emergency and

urgent care

• Provide clarity about the arrangements to transfer sick

children quickly from Urgent to Emergency Care

• Support parents now through effective communication

plans and campaigns.

• Specifically consider children in any future commissioning
• f NHS 111.

Deliberation Recommendations

Full Business Case

• Many of the findings recognise that further detail is

required

• Full Business Case – five case Model
• A Full Business case develops further detail
• In developing a FBC- the CCGs would;
• Undertake further work with Partners and Key

Stakeholders

• Travel group
• Continue to work with JHOSC/ Clinical senate
• Undertake NHSE’s assurance process

• Background
• Deliberation
• Purpose
• What we considered
• Findings
• Full Business Case
• Recommendation

Summary

Recommendations Legal Obligations and Duties

In considering the recommendation you must consider:

• The consultation report.
• NHS England's four key tests for service change
• NHS England’s comments on previous assurance.
• The consultation mandate.
• Section 14Z2 of the NHS Act 2006.
• The general law on running fair consultations
• The EHIIA and your Equality and Health Inequalities Duties.
• The Healthwatch Survey (Calderdale and Kirklees).
• The Kirklees LMC response to the consultation.
• JHOSC's recommendations
• The Key Messages from the Stakeholder Event

Recommendations

The Governing Body is asked: To consider the findings from the consultation and the documents listed above and decide how it would like to proceed, including whether to proceed to Full Business Case, and/or whether any other steps should be taken. If the decision is taken to proceed to Full Business Case, to approve or amend the response to NHS England (paragraph 4.5) and the JHOSC recommendations (Appendix D).

Recommendations (cont.)

The Governing Body is invited to note that if a decision is made to proceed to full business case, this will need to be developed and submitted to key stakeholders for comment (including NHS England, NHS Improvement; DH; and JHOSC), before a final decision is made about whether to proceed. Any changes between the Pre-Consultation Business Case and the Full Business Case which will have an impact on the services available to individuals may require further involvement of stakeholders.

Questions