A Meeting in Common of the NHS Hartlepool &
Stockton-on-Tees Clinical Commissioning Group and NHS Durham
Dales, Easington and Sedgefield Clinical Commissioning Group
Governing Bodies
Monday 2nd September 2013, 1:30-3:30 pm
Hartlepool College of Further Education, Conference Centre
CONFIRMED MINUTES
Present
Dr Boleslaw Posmyk (PB)
Neil Atkinson (NA)
Brian Dinsdale (BD)
Ken Lupton (KL)
Claire Young (CY)
Mary Bewley (MB)
Roger French (RF)
Jean Fruend (JF)
Dr Charles Stanley (CS)
Graham Niven (GN)
Dr Bhadrash Contractor (BC)
Hilary Thompson (HT)
Dr Nick Timlin (NT)
Dr Mike Smith (MS)
Ali Wilson (AW)
Annie Dolphin (AD)
Mike Taylor (MT)
Joseph Chandy (JC)
Gillian Findley (GF)
Peter Carr (PC)
David Taylor-Gooby (DTG)
Keith Tallintire (KT)
Deborah Perry (DP)
Paul Garvin (PG)
Alan Foster (AF)
Julie Gillon (JG)
David Emerton (DE)
Governing Body Chair, Hartlepool & Stockton-on-Tees Clinical
Commissioning Group (HaST CCG)
Deputy Director of Finance and Information, North Tees and
Hartlepool NHS Foundation Trust (NTHFT)
Deputy Chair, Non-Executive Director, NTHFT
Non-Executive Director, NTHFT
Head of Communications, NTHFT
Head of Communications and Engagement, North of England
Commissioning Support (NECS)
Director of Finance and Resources, North East Ambulance
Service (NEAS)
Executive Nurse, HaST CCG
Secondary Care Consultant, HaST CCG
Chief Finance Officer, HaST CCG
GP Member, HaST CCG
Lay Member for Public and Patient Involvement, HaST CCG
GP Member, HaST CCG
GP Hartlepool Locality Lead, HaST CCG
Chief Officer, HaST CCG
Governing Body Chair, Durham Dales, Easington and Sedgefield
Clinical Commissioning Group (DDES CCG)
Chief Finance and Operating Officer, DDES CCG
Director of Performance and Information, DDES CCG
Director of Nursing, DDES CCG
Secondary Care Clinician, DDES CCG
Lay Member for Public and Patient Engagement, DDES CCG
Lay Member Audit and Assurance, DDES CCG
Corporate Services Administrator Coordinator, Minute-taker in
attendance, DDES CCG
Executive Chairman, NTHFT
Chief Executive, NTHFT
Deputy Chief Executive and Chief Operating Officer, NTHFT
Medical Director, NTHFT
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Jean McLeod (JM)
Narayaran Suresh (NS)
Claire Curran (CC)
Heidi Holliday (HH)
Kerry McLean (KM)
Debbie Lamming (DL)
ITEM
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Clinical Director of Medicine, NTHFT
Clinical Director of Anaesthetics, NTHFT
Director of Human Resources and Education and Company
Secretary NTHFT
Private Office Manager, NTHFT
Minute-taker in attendance, Administration Assistant, NECS
Minute-taker in attendance, Administration Assistant, NECS
SUBJECT
Welcome and Introductions from Joint Chairs of the Meeting
ACTION
PB welcome everyone to the meeting in common of the Hartlepool and
Stockton-on-Tees Clinical Commissioning Group (HaST CCG) and the
Durham Dales, Easington and Sedgefield Clinical Commissioning Group
(DDES CCG) Governing Bodies relating to the proposal to centralise the
emergency medical and critical care services at the University Hospital of
North Tees.
PB explained that the meeting was being held in public but was not a public
meeting where questions could be taken directly from the public. Members
of the public were present to observe and to ensure involvement in the
process. PB stated that the Governing Body members of both CCGs
would make themselves available for half an hour at the end of the meeting
to discuss matters with attendees and take any questions.
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Declarations of Interest
There were no declarations of interest made.
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Apologies for absence
Dr Stewart Findlay, Chief Clinical Officer, DDES CCG
Dr Dinah Roy, Director of Clinical Quality and Primary Care Development,
DDES CCG
Dr Helen Moore, Clinical Locality Lead, Sedgefield Locality, DDES CCG
Dr Stephen Muscat, Clinical Locality Lead, Easington Locality, DDES CCG
Dr Satinder Sanghera, Clinical Locality Lead, Durham Dales Locality,
DDES CCG
Dr John McGuire, Sessional GP, DDES CCG
Dr Paul Williams, GP Stockton Locality Lead, HaST CCG
Steve Smith, Lay Member for Governance and Audit, HaST CCG
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Proposal to centralise emergency medical and critical care services
at the University Hospital of North Tees
PB explained that the two CCGs needed to consider the proposals put to
them by the Acute Trust regarding the changes to NT&H hospitals. The
meeting would be chaired by both CCG chairs with the first part being
received in the form of a presentation from NTHFT on the clinical case for
change and the consultation process.
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The second part of the meeting would be the opportunity for the
Governing Body members of both CCG to put questions to the
presenters.
DDES CCG would then run through their decision-making process
followed by HaST CCG, with the public in attendance to witness this.
Following the separate Governing Body decision-making process next
steps would then be discussed.
AW checked that everyone present had seen and read the consultation
documents, which was confirmed. All papers had been uploaded to both
CCG websites. The key reports had taken into account all legal
requirements of the Secretary of State. AW set the scene by referring to
the changing needs of patients and how medical care is changing now
and in the future. CCGs are more aware than ever of an ageing
population, far more complicated disease patterns, the increasingly
complex and multiple health needs of patients. Higher standards,
availability of medication, providing care closer to home and the best
possible discharge care make it increasingly difficult for NTHFT to provide
services and the highest standards across the two hospital sites. As an
organisation NTHFT has always been very proud of achieving the highest
clinical standards with the best possible care for patients and are driven
by very specific clinical guidelines which encourage cooperative working.
The Trust strives to maintain these standards and will continue to do so in
the future.
Changes were needed because of the difficulty of sustaining two units;
this issue was discussed in detail within the Trust and brought to the
attention of commissioners who were appraised of the situation.
NS explained that historically intensive care was always viewed as a subspeciality of anaesthetics but that the General Medical Council (GMC) last
year recognised it as more than this. It is now more difficult to achieve
national body standards and it has proven difficult to recruit staff to such a
small unit as existing staff feel unsupported and concerned regarding the
possibility of clinical errors, maintaining clinical qualifications and,
therefore, standards of care. The main aim of NTHFT is to make the
service as safe as possible, hence the rationale behind the proposed
changes.
The National Clinical Advisory Team (NCAT) spent time looking at the
services provided and recognised a potential clinical risk and differences
in equality of services offered to North Tees and Hartlepool patients (for
example patients experiencing medical complications at Hartlepool need
to be moved to another site and those at North Tees only need to be
move to another floor of the same building).
Options for reducing risks were considered for both sites (see Appendix
A) by NCAT and NTHFT; for example increased staffing levels, increased
working hours, changes to patient pathways. The possibility of running
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the two units in parallel was considered but this was advised against.
NCAT advised NTHFT that they were correct in recognising and
addressing clinical safety concerns and that the service was
unsustainable. Redesign of the service by centralising intensive care at
North Tees, with medical care following, was viewed as the safest and
most viable option available.
Final assessment from NCAT advised that changes should be made as
soon as it was safe to do so and as soon as possible.
NTHFT concluded that to maintain the standards and highest quality of
care for patients already established in the catchment area centralisation
of critical care and medicine at the North Tees site could be the only
recommended option.
NTHFT has acknowledged that the recommendations need to be followed
through and that if the health service is to be fit for the future
centralisation is required but also that the consultation process has
brought concerns from the public around several areas. The Trust is
committed to providing care closer to home of the highest standard and
will do their utmost to support members of the public as a result of the
proposed changes. A steering group made up of representatives from
Healthwatch, CCGs, Commissioning Support and the Trust was set up to
work on the consultation process and key messages to the public were
highlighted in their consultation report, as below.
AW reminded attendees that 97% of healthcare contacts currently being
dealt with in Hartlepool will continue and that the proposals would affect
approximately 30 patients per day from Easington and Hartlepool. No
change to the point of access is planned and patients will still need to
contact their GP, 111 or 999 as previously. Extra beds will be made
available at North Tees and the staff from the emergency medical ward
and critical care staff from Hartlepool will move to North Tees. The
majority of health services for patients will continue to be delivered
through GP practices and other community services as usual.
MB stated that to ensure requirements of the four tests (see slide content)
had been met and to strengthen patient and public involvement the
consultation process was underpinned by the steering group at all points.
As part of the process as wide a range as possible of communication
access points was provided; face to face meetings, internet, email,
telephone, and independently evaluated questionnaire, websites, a
summary leaflet to GP practices and delivered door to door, local media
and networks, drop in sessions and market place events, community
meetings, events for governors and the public. All were good
opportunities for people to talk and to feed back about the process and all
were documented and recorded.
Output of the consultation resulted largely in negative responses but
people felt very passionate and did not want a reduction in hospital
services. However most agreed, once an understanding of the clinical
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argument was reached, that the changes are the safest and most
sensible course of action.
One of the main issues identified was transport and the lack of
information available to patients. The consultation process was used to
consider all transport-related issues and CCGs were reminded that in
commissioning services they are expected to consider the transport
needs of patients.
An exercise was undertaken as part of the process which looked at,
amongst other things, travelling times between Hartlepool and North Tees
and mitigation plans are being considered for the issues identified;
additional shuttle services, discount travel costs, collaborative work
between the CCGs and the Trust, application for additional car parking at
North Tees, volunteer driver scheme improvements, park and ride
systems, car sharing and shuttle transport for staff including shift pattern
studies and coordination.
It was highlighted that the patient transport service provided by NEAS
was sometimes untimely, often resulting in missed appointments and long
waits for the elderly. These issues are being considered to ensure the
service is more accessible and practical. The Trust and CCGs are
working with NEAS to ensure transport needs are met as identified by the
public.
HaST CCG recognise that providing services closer to home is a priority
for patients and is working collaboratively with DDES colleagues all the
time to achieve this. GPs in both CCG areas, although disappointed
about the proposals, have been involved in the consultation from the start
and agree that from a clinical safety viewpoint the planned changes are
the safest option for their patients. It was reiterated that NCAT feel very
strongly that all clinical evidence points to the move as the right thing to
do.
The Trust and the CCGs have an ongoing quality assurance process in
place to assure, and be assured, that all quality and safety concerns are
met.
Patient Choice exists for planned care (elective) already but not
unplanned care (non-elective) and this will not change except for a small
number of surgical patients.
Other statutory requirements have all been met as part of the process
(Health and Social Care Act and equality assessments).
The main issues raised as part of the process:
High quality is paramount
Patient safety cannot be compromised
Understanding concerns regarding loss of services
Transport
Close working with partners
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Need to provide better public information and communication
How we will address these:
Each GB was asked to consider the clinical case for change and all
feedback from the public consultation and agree next steps today. NCAT
had pointed out in the report that as commissioners CCGs had to assure
themselves of the provision and safety of services at North Tees and
those left behind at Hartlepool.
JF confirmed that the Clinical Quality Review Group meets regularly and
has received assurance from all parties that clinical quality concerns have
been met using a very robust consultation process.
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Opportunity for the Governing Body members to raise questions and
issues
Q1 If the proposals did not go ahead, how will current services be
maintained?
A1 Current services could be maintained; however, whether these can be
sustained is unclear.
Q2 JF asked what the issues were regarding recruitment to the critical
care unit.
A2 NS responded that although there were no real issues with recruiting
to one service, if it was run over two sites the Trust would have to
consider recruiting a further 10 consultant physicians and double the
junior doctor cover for all shifts including Out of Hours. Recruitment to a
small intensive care unit is deeply unattractive as jobs have become more
specialist and therefore more competitive. It is now more challenging to
work towards the required quality of care standards and, at the same
time, retain high quality personnel across two sites.
Q3 PC asked whether, in the long term, there would be issues for
consultants working across two sites with regard to continuity of care, ie
who looks after patients once they have been moved? What are the
transfer arrangements from one site to the other?
A3 There is disruption to continuity of care at the moment as when
patients are moved the “parent team” changes, which can be difficult for
families concerned. In the new model patients would be discharged to
the rehabilitation unit and cared for by the elderly care team, who are
effectively the gatekeepers for the unit. This will apply to any patients
with limited continuing medical needs but with the need for rehab,
occupational therapy and input from other services, with a view to their
planned care being picked up by the Care Closer To Home services
(using a step down / sub-acute approach, designed to be part of the
“looked after in your own home” teams). It is vitally important that
continuity is reassured, in effect improving the service for these patients
with the changes. This care is provided by colleagues working under a
multidisciplinary service.
This new model is a completely different approach which depends on the
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needs of the patient, being built around them and not around the service
team.
Q4 DTG asked whether these changes would lead to further services
being moved out of Hartlepool into other local sites, for example
Sedgefield Community Hospital?
A4 The Trust has had discussions with Dr Stewart Findlay, Chief Clinical
Officer for DDES CCG, and are already engaging with clinical leads,
particularly around stroke, to see if Sedgefield Community Hospital can
be utilised. The Trust reiterated that it will continue to work to ensure
pathways are optimised within the community with key milestones
achieved around care closer to home.
Q5 Will the seven day working arrangements be affected by the new
developments?
A5 Seven day working has been in effect in both hospitals for acute
services for two years already and this will continue as well as
considering the possibility of a seven day working model for outpatients at
one site, as this may enhance earlier consultant intervention into the
patient’s disease journey. The current seven day working model for
intensive care meets national standards.
JC – The Trust is working closely with DDES and Easington locality in
particular, being part of the Care Closer To Home subgroup taking
integrated pathways forward, working collaboratively with Durham County
Council and County Durham and Darlington NHS Foundation Trust.
Working to improve pathways, recruiting to an older peoples’ team, for
example, to ensure pathways are provided in an appropriate setting.
Transport
HT – The Trust and CCGs will work hard with local authorities to improve
all transport issues raised as an outcome from the consultation process;
accessibility, cost, travelling time, major areas of deprivation in the area,
low numbers of car users. Reassurance has been provided by NEAS that
they will work to achieve a sustainable transport system for patients.
Q6 KT expressed his gratitude that assurances have been received but
asked for more detail about what was planned?
A6 RF – This review of hospital services is not a new process for them,
successful development models have been formulated previously and
NEAS will continue to improve the patient journey.
Q7 PB asked what assurance NEAS could provide to patients over
concerns whether ambulances having to travel further would affect patient
safety.
A7 RF referred to appreciation of the skills of paramedics who would
receive improved training on top of what they have already. A longer
journey would be necessary but paramedics will provide the same care
and attention they give to all patients during the journey.
Q8 AW – Transport congestion – Has NEAS envisaged further difficulties
around this?
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A8 RF – If an accident happens or congestion occurs vehicles already
have direct access to other emergency services and mapping devices.
Q9 AD – Parking will be increased with the convergence on North Tees.
What is the plan? How does the Trust propose to marry patient
appointments up with patient transport timetables?
A9 Car parking will be provided on a temporary basis for staff who will
move there to create more public spaces. A bid has been placed with the
Local Authority for additional car parking spaces and the Trust are
working with staff to consider alternative ways of travelling, car sharing,
shuttles etc. With regard to Outpatient appointments for patients,
particularly the elderly, Patient Transport Service is not part of this
consultation but the Trust is looking at alternative travelling times which
would be more sensitive to the needs of elderly patients. Volunteer driver
scheme extensions are being considered. All were reminded that the
Trust relies on the public to alert them to transport issues so they can act.
AW also pointed out that transport measures for disability access spaces
are being taking into account and CCGs are working collaboratively with
Healthwatch with regard to this, ensuring that staff who are also
wheelchair-users are considered also.
Q10 PB – Could the services have been moved to Hartlepool instead?
A10 The Trust considered internal options, ie all acute medicine and
intensive care services move to Hartlepool rather than North Tees but
due to the fact that these services would not all fit into Hartlepool it was
not considered a viable option.
Q11 PB – There is space at Hartlepool to build – why not?
A11 There is a population in Stockton of approximately 190,000 and 9099,000 in Hartlepool. If a new hospital was built in Hartlepool this would
not be central to the whole population and funding was not available.
Q12 PB/AW Why was there only one option in the consultation?
A12 AW All clinical and quality safety issues were considered and not
taken at face value. NCAT assessed independently along with clinical
experts who agreed entirely that the option put forward was the only safe
and viable one. It would not have been appropriate for an open and
transparent commissioning body to then look at other options. Of course
if there had been clinical evidence to the contrary other options would
have been considered but none were provided. It would have been
remiss of the CCG to move forward with the proposals without looking
also at the impact on the population and mitigation of issues raised during
the consultation process.
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Summary and Governing Body decisions
There were no further questions and AD summed up the discussion and
said that the questions asked showed the robustness of the information
received. All the information received showed a consistent picture which
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was reassuring.
The summary report was helpful and explained why this change needs to
be made. AD asked whether the Trust have plans to implement the
changes, and their response was that the Trust does have a plan to
implement the changes if approved. The proposed date for
implementation is October 2013 to ensure that the changes are made
before the onset of winter.
AD referred to the County Durham Overview & Scrutiny Committee report
– the CCGs would want to ensure that the implementation process was
monitored so their suggestion of an oversight group was very helpful.
DCC had been part of an oversight group that was set up when changes
were being made to County Durham and Darlington FT hospital services
and that group gave assurance that issues and actions identified in the
consultation were considered and taken forward
AD explained that DDES CCG would now hold their Governing Body
meeting in pubic and were reminded that the purpose of the meeting in
common was to meet together with HaST CCG and the Trust to review
the proposal, the outcome of the consultation and assess the robustness
of the process and plans.
AD formally asked the DDES CCG Governing Body members present to
confirm individually whether they were in agreement with the proposal
and the plans to address the concerns of the public, the CCG and County
Durham Overview & Scrutiny Committee. All members confirmed their
agreement subject to plans to address the concerns being in place and
implemented.
PB explained that HAST CCG would now hold their Governing Body
meeting in public and were reminded that they were quorate and that the
purpose of the meeting was to receive a presentation from the Acute
Trust around the changes to Acute care, the challenges to the Acute
Trust, reasons for the changes, to agree that safety issues had been met,
with a particular note to transport issues and whether they had reached a
decision to support the changes.
PB formally asked the HaST CCG members present to confirm whether
they were happy to proceed on that basis. All members confirmed their
agreement.
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Next Steps
AW summarised the actions which had been identified during the
discussion:
- Monitoring from the oversight board
- Evaluation of the travel plan, ensure that this is working well and
delivering sustainable ways of working with partners
- Communication with the public – improvement by all
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- Working with Local Authority colleagues
- Monitoring quality and safety
- Strengthening local services
AW explained that dates are in diaries already for meetings to take plans
forward and the Trust and CCGs recognise that steering group members
need to be included.
This group needs to be extended to ensure the right people are involved,
everyone was in agreement that AW would liaise with Stewart Findlay and
Mike Taylor from DDES CCG on this as soon as possible to avoid further
delays.
It was agreed that plans need to be implemented before the winter period
(towards the end of October) and information need to be communicated to
the public and staff immediately after this meeting, including dates for
changes. This communication should also be conveyed to those involved
in any pathway changes.
The Trust concluded the meeting in common by stating that over the past
years the Trust’s Board of Directors have challenged the rationale behind
delivering such a plan, internally as well as over the past few months
working externally with the CCGs looking at the plans and challenging
these again. The process has moved the Trust to a place where it is happy
to work very closely together with partners to continue to deliver the safest
services possible for their patients. Thanks were given to everyone
involved in the work done so far.
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Any other business
None
The meeting closed at 3:15 pm.
Signed ……………………………………………
Name …Annie Dolphin ………………………..
Date ….. 10th October 2013…………………..
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