Board Meeting of the Governing Bodies Ossett Town Hall 25 July 2013

1. Board Meeting of the Governing BodiesOssett Town Hall25 July 2013

2. Dr Phil Earnshaw Chair NHS Wakefield Clinical Commissioning Group

3. Dr David Kelly Chair NHS North Kirklees Clinical Commissioning Group

4. 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

5. Mid Yorkshire Health & Social Care Partnership Transformation Programme Care closer to home Maternity, children & young people Mental health & learning disability Urgent care Clinical Services Strategy

6. Development of the Clinical Services Strategy

7. Dr Simon Enright The Mid Yorkshire Hospitals NHS Trust Consultant and Lead Clinician (CSS)

8. Maternityservices– the proposals Dewsburymidwife-led unit‘low risk’ : home, midwife unit or Pinderfields‘high risk’: deliver at PinderfieldsPinderfields ‘high risk’ births: all to consultant-led unit‘low risk’ births: home, midwife-led unitPontefract no change: midwife-led unit‘low risk’: home, midwife unit or Pinderfields‘high risk’: deliver at PinderfieldsLocal antenatal/postnatal care

9. 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

10. Emergencycare – 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

11. Emergency care (contd) • Pinderfields • specialist trauma and emergency care centre for Mid Yorkshire • centre for emergencies needing inpatient care • 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

12. Surgery – the proposals • Dewsbury • 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

13. Pat KeaneInterim Programme DirectorMeeting the Challenge Quality Impact Assessment/ Integrated Impact Assessment

14. Presentation for Joint CCG Board meetingGraeme Wilson Ossett Town Hall 25 July 2013

15. 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

16. 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 consider Phone poll 49% overall quite or very concerned

17. By area

18. 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

19. 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

20. 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

21. Transport The 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

22. 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

23. 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

24. 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

25. 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

26. Questions from the Governing Bodies

27. Martin Carter Head of Communications & Engagement Meeting the Challenge

28. Joint Advisory and Review Group (JARG) • 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

29. JARG conclusions • 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

30. JARG recommendations • 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

31. JARG recommendations (contd) • 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

32. Pat Keane Interim Programme Director Meeting the Challenge

33. Changes to original proposals/ambitions and conditions 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.

34. GP commissioning support Patient Choice Strengthened patient/ public engagement Clarifying clinical evidence

35. Recommendations 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 Agree that the paper is the CCGs’ response to the consultation, taking into account the full range of views Receive the independent report on the consultation and confirm that there has been robust consultation on the proposals in the Clinical Services Strategy 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

36. Recommendations(contd) 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 localunless for sound clinical reasons – this should startwithin 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

37. 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.

38. Recommendations(contd) • 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

39. 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

40. Recommendations(contd) Agree to progress transformation in the community through integration across health and social care Approve the commissioners’ ambitions and conditions set out in section 6. 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.