Governing Body Q&A 2017 Governing Body Q&A 2017

Governing Body - Thursday 23 November 2017

Q. I would like to ask the CCG about any plans for regular and accessible communications to provide clear and accurate updates for the people of Whitby and the surrounding area, on the redevelopment of the Whitby Hospital site, both in respect of the health services and the plans for extra care housing on the site. I know that there are regular discussions and ongoing developments of the plans to bring this major project to fruition, but in the absence of regular updates specifically for the population most impacted by the development, my understanding is that local people are feeling disempowered, and under-informed. Surely having the population fully engaged in the discussions, better understanding the challenges and contributing to the planning would be one positive way to ensure services match local needs.

A. Gill Collinson said the CCG have been working with the wider design team and tenants of the hospital to understand fully some significant financial aspects of the projects, these were complex in nature and unexpected due to national policy changes and have taken up a significant amount of capacity from the team to get to a position of being able to provide assurance to the Governing Body through the outline
business case. The CCG appreciates that during this time our work has been largely behind the scenes which may have been concerning for some members of the public. We have continued to brief the Hospital Infrastructure Group on a regular basis, as updated information on progress has become available. This group consists of PPG members, Healthwatch, Whitby Hospital Staff, HEN members and the Whitby Civic Society. We have also briefed the North Yorkshire County Council Scrutiny for Health Committee and Scarborough Borough councillors. We will continue to do this and also publish updates in the Whitby Health News which is a local newsletter and disseminated to a range of local sources. Following the decision and if approved, this will commence a series of more formal launch events with the Construction Partner for the health scheme which will focus on the design development, these will be regular and locally accessible, the CCG will also use its established communication networks to provide regular updates on the scheme as it progresses. Jane Warburton noted that there had been gaps which had been filled by rumours. Gill acknowledged this and advised that it was a lesson learned and the CCG would endeavor to ensure there were no gaps in communication in the future.

Q. Could the CCG confirm if money has been allocated to progress the hospital refurbishment project and could an update of the project be given? Secondly can the CCG advise what progress has been made with NYCC with regard to the development of extra-care housing on the remaining land?

A. Bernard Chalk said the business case for Whitby Hospital was an item on today’s agenda and this question would be covered under that agenda item.

Q. What is happening with mental health in the Whitby area?

A. George Campbell said the recent Hambleton and Richmondshire mental health consultation did not include the Whitby area. Whitby patients who are admitted for mental health inpatient care go to the excellent facility at Cross Lane in Scarborough and this pathway remains unchanged.

 

 

 

Governing Body - Thursday 26 October 2017

Q. Poor mental well-being causes distress to sufferers, puts stress on their families and increases costs to the NHS. It is well-known that it shortens lives: for example, studies have shown that social isolation reduces life expectancy by seven years, making it an issue of public health on a par with smoking. So it is vital that the causes are addressed as early as possible, before a critical stage is reached. In many cases, this can be done without expensive medical interventions, and social prescribing can play a significant role. What action does HRW CCG propose to take in the two areas of Early Intervention and Social Prescribing to alleviate the misery of sufferers and their families, and to save the NHS clinical time and money?'

A. George Campbell said early intervention and social prescribing are important. The CCG are committed to investing in community services. An integral part of managing people’s mental well-being is our partnership with NYCC health and social care, the Stronger Communities programme and Public Health. The system is working collaboratively to strengthen community capacity through innovative approaches to prevention and early intervention.

Q. Will the CCG ensure that as part of the restructuring that voluntary sector providers of mental health  services will be funded to provide entry level services either directly through the CCG or via sub-contracting arrangements with TEWV(?) This recognises the huge contribution the VCS makes to relieving pressures on the NHS by diverting people away from primary and secondary care.

A. Gill Collinson said the services provided from the voluntary sector play a vital role in supporting people in their own communities and this consultation provides us with an opportunity to bring those services into the wider system model in a more coordinated way. The CCG will require TEWV to sub-contract elements of this work to the voluntary sector and this will be set out in our commissioning strategy and specification.

Q. Official figures show that there are 2,300 people living with dementia. In Hambleton, Richmond and Whitby the average age of diagnosis is 85 years old with such people, again on average, having 5 other conditions. Is it reasonable to expect such people, amongst the most vulnerable in our society, with differing degrees of cognitive impairment, memory loss and confusion to travel to Bishop Auckland for in-hospital treatment? From Northallerton to Bishop Auckland by train means a change at Darlington and a walk from Bishop Auckland station to the hospital. By bus the journey is even more problematic.

A. Gill Collinson said when anyone suffers with organic illness it is traumatic for them and for those around them. The clinical definition of organic illness as severe is when it manifests along with ‘behaviours that pose a risk either to the patient themselves or to others’. Older people who have clinically severe organic
mental health issues already go to Bishop Auckland and we are not proposing to change that pathway. In 2016/17 only two patients from the Hambleton and Richmondshire areas were admitted to the Bishop Auckland facility. Gill apologised for any confusion and reiterated there would be no change to the
current pathway.

Q. The minutes of the NYCC Health Scrutiny Committee on 22 September record that Janet Probert stated in relation to changes at the Friarage Hospital that: “No deals were being done behind closed doors and the process would be open and transparent”. Can the CCG now give a categorical assurance that no financial or other inducements have been offered, directly or indirectly, by South Tees NHS FT to TEWV NHS FT to encourage them to vacate the MH wards in the Friarage, and whether relating to the new proposed Community Hub or otherwise? And if not, has the CCG sought and/or obtained similar assurances from both South Tees and TEWV as to whether or not such inducements exist?

A. Janet Probert said we can give categorical assurance that no financial or other inducements have been offered in any way to any party. I have regular meetings with Colin Martin (TEWV) and Siobhan
McArdle (STHFT) and can give assurance that there is total openness and transparency. Colin Martin added that no inducements had been asked for or given and also gave full assurance.

Q.  I could go on about the reports from the CQC, The Kings Fund and the Royal College in particular relating to a shortage of beds nationally and the increase in usage over the past two years. However we have only a short time allotted for questions and I am sure there are others. Your report is over 300 pages long and buried in the back of the report is numerous reports and letters expressing concern mainly from people and organisations based locally. If you take account of the groups of people those letters represent they far outweigh those who voted for Option 2. Are they all wrong? What has changed as a result of this consultation? Have we all wasted our time?

A. Gill Collinson said we do not consider those people and groups who expressed concern regarding the preferred option to be wrong or to have wasted their time. In response to feedback received throughout the
engagement period we directly changed the options to:

  • present a single site inpatient option (Option 3) because the public told us that’s what they wanted
  • have bookable adult mental health appointments on 6 days instead of 7 because people told us that they didn’t want bookable appointments on Sundays (intensive home treatment and crisis care will clearly still be available 7 days a week)
  • include more explicit detail on how allied health professionals and the voluntary sector could be a part of the proposed new model because people told us that this wasn’t clear.

Developments also progressed throughout the consultation period which enabled us to expand on the crisis and home treatment responses, community mental health models, care home in reach  and dementia care. However, when taking all feedback into account, Option 2 emerged clearly as the most supported and it is
for this reason that it is recommended to the Governing Body today.

Q. Is the real reason why Option 4 wasn’t presented to the public, the fact that the public would choose it and you have already decided that you want to close the Wards regardless of what your customers want?

George Campbell said: A new build, all-age adult functional assessment and treatment facility on the Friarage Hospital site was not viable to take forward for public consultation for three significant reasons.
Firstly, it is not safe or clinically appropriate and directly contravenes the Royal College of Psychiatry guidance. Secondly, it is not financially viable due to the significant additional capital implications associated and thirdly, the focus of the service would remain on inpatient provision, not on increasing the availability of care in community settings, and this is in direct opposition to what service users and the public have told us that they want.

 

Governing Body - Thursday 28 September 2017

Q. What Measures are being taken to improve recruiting of doctors and nurses so that the Friarage can be brought up to full strength?

A. Dr Mark Hodgson advised that the CCG is in regular discussion with South Tees Hospitals NHS FT about the current workforce challenges at the Friarage Hospital. The most significant challenge is the recruitment of anaesthetists and some of their recruitment efforts include:

  • A continued advertising campaign across both sites
  • Developing a more targeted recruitment campaign with recruitment stands at national conferences of anaesthetists in Edinburgh and Liverpool and an acute medicine conference in London
  • Having an improved presence on digital media with a careers microsite and video links to the BMJ website, all running alongside targeted national and international campaigns to attract people to both our hospitals and our region.
  • Specifically targeting countries with a higher percentage of trained anaesthetists per head of population.

Q. What is the current position of maternity and paediatric services at the Friarage? Has a second consultant been recruited?

A. Dr Mark Hodgson advised that maternity services available at the Friarage Hospital continue to be a midwifery led unit. A short stay paediatric assessment unit has been in operation since October 2014 and whilst A&E treat children with minor injuries, all urgent and emergency cases involving children go to James Cook University Hospital as the Friarage Hospital does not have a paediatric inpatient (overnight ward).

Q. What are the current paediatric assessment unit opening hours?

A. Dr Charles Parker advised the unit was open 5am –7pm Monday – Friday.

 

Governing Body - Thursday 25 May 2017

Q. Can the HRW CCG please confirm its position on compliance in 2017/18 with the Mental Health Investment Standard (MHIS). Does the Governing Body endorse this position?

A. Bernard Chalk noted that the CCG met the requirements and spend on Mental Health was significantly more than was funded for and more than other CCG’s.

Q. The Communications dashboard circulated with the agenda gives the monthly number of new visitor and returning visitors to the CCG’s web site overall. What are the numbers of new visitors and returning visitors to the Transforming Mental Health Services page of the web site?

A. Gill Collinson noted there were 52 new visitors and returning visitors to the Transforming Mental Health Services page of the web site. This number was very low but was not unusual and would increase over time.

Q. One of the standard measures of the CCG Improvement and Assessment Framework (presumably item 22 on agenda as “Assurance Framework” with documents to follow) is out of area placements for acute mental health inpatient care (item 123e, part of Better Care). Is this a measure of “out-of-CCG-area” or “out-of-TEWV-trust-area” or something different, and is the determination of which measure to apply one for the CCG, for NHSE, or a joint decision? 

A. Bernard Chalk noted that ‘Out of Area Placements’ was work in progress. Bernard apologised for the data not being clear and asked if he could clarify at a later date.

 

Governing Body - Thursday 23 March 2017

Q. Can the HRW CCG please confirm its position on compliance in 2017/18 with the Mental Health Investment Standard (MHIS). Does the Governing Body endorse this position?

A. Bernard Chalk noted that the CCG met the requirements and spend on Mental Health was significantly more than was funded for and more than other CCG’s.

Q. The Communications dashboard circulated with the agenda gives the monthly number of new visitor and returning visitors to the CCG’s web site overall. What are the numbers of new visitors and returning visitors to the Transforming Mental Health Services page of the web site?

A. Gill Collinson noted there were 52 new visitors and returning visitors to the Transforming Mental Health Services page of the web site. This number was very low but was not unusual and would increase over
time.

3. One of the standard measures of the CCG Improvement and Assessment Framework (presumably item 22 on agenda as “Assurance Framework” with documents to follow) is out of area placements for acute mental health inpatient care (item 123e, part of Better Care). Is this a measure of “out-of-CCG-area” or “out-of-TEWV-trust-area” or something different, and is the determination of which measure to apply one for the CCG, for NHSE, or a joint decision? 

A. Bernard Chalk noted that ‘Out of Area Placements’ was work in progress. Bernard apologised for the data not being clear and asked if he could clarify at a later date.

 

Governing Body - Thursday 26 January 2017

Q. Would the CCG support a request for one of the Arriva buses from Whitby to be rerouted to pass James Cook Hospital so that patients don't have to go into Middlesbrough to catch another bus to the hospital?

A. Charles Parker advised he had written to both Arriva and the Scrutiny Committee of North Yorkshire County Council for Environment and Transport asking them to support the change but he had received a response from Arriva advising they were unable to re-route any of their buses due to Marton Road being a busy and congested road.

Q. Are the CCG aware that patients from our area are being referred to Malton Hospital for investigations re e.g. sebaceous cysts and then referred on to York Hospital for treatment? If yes, is there any way initial investigations can be carried out in Whitby as the current position involves miles of travel, made even more difficult and expensive if a patient has no transport of their own?

A. George Campbell advised that the CCG were in ongoing discussions with South Tees Hospitals NHS FT.  It was noted that patients could decide where they were referred to through patient choice. Sebaceous cysts were considered to be cosmetic and were excluded from NHS treatment unless they were an exceptional case.

Q. Is there a way of re-cycling disability aids given out by the NHS to patients for their short term use after their operations as in hip or knee replacements perhaps.  (One of the network could not get anyone to collect the ones they had and then someone came back and said ‘ditch them’ as they cannot be reused due to ‘health & safety). Could there be a ‘deposit’ area in hospitals for these aids? As the contract for wheelchairs has just been re-allocated, does this service re-use wheelchairs that have been returned?

A. Under the new community equipment contract, if a patient no longer requires a piece of equipment they can call Medequip on 01423 226240.  Medequip are contracted to collect equipment (as requested by patients), within 5 working days of the request being made.  Medequip will collect equipment that has the Medequip label on and/or labels for the incumbent provider (i.e. HDFT).  It may have been that the equipment referenced above was out of area / not our local equipment.  All collected equipment is reviewed by Medequip and if suitable for recycling, will be repaired/decontaminated and returned to stock for re-issue. 

Commissioners have committed to exploring the provision of an equipment amnesty in 2017 working with Medequip.  We are keen to explore a publicity campaign and look at the provision of amnesty bins in key locations across NY to encourage the return of equipment and recycling. 

The wheelchair service is contracted to collect wheelchairs from patients when no longer required (within 5 days of the request being made). Again, similar to equipment, the service provider; NRS will review the item and if suitable for re-use will repair (if required), decontaminate and return to stock so that it can be re-issued for another patient if it is suitable. 

Q. A recent FOI response by HRWCCG confirmed that the CCG fell short (by £144k on baseline mental health spending of £20.7m) to meet the Mental Health Investment Standard (previous called the Parity of Esteem MH Funding Commitment) for 2016/17.

  • Will the CCG be meeting this target for 2017/18, as a definite “must-do”?
  • Will the starting point for 2017/18 be the actual MH spending in 2016/17, or the spending as if the target had been met in that year?
  • Are there any plans to make good the shortfall in MH spending in 2016/17 of £144k?  

A. Janet Probert advised that there had been significant investment in mental health over the last few years. The CCG allocation is 8% for mental health and the CCG have spent more than 10%.  It was noted that Roger Tuckett had previously received a detailed response from Debbie Newton to what was thought to have been a similar question.

The starting point for 2017/18 will be the outturn from 2016/17. Because of the CCG financial position it has not planned any additional investment in mental health.

Q. Requesting action on Whitby Hospital – why is there a delay? Why have NYCC not progressed any proposals for Whitby? Which Council is responsible for Whitby as excluded from latest SBC Health and Welfare policy? Why is Whitby not mentioned in the STP apart from in the title?

A. Gill Collinson noted that a media release on the re-modelling of Whitby Hospital had gone out on 24 January 2017 and the reason for the delay was due to the market rents but things were now progressing again.

It was noted that the questions regarding NYCC not progressing proposals for Whitby and which Council was responsible for Whitby should be directed to North Yorkshire County Council for a response.

Janet Probert advised that the CCG were fully a part of the Darlington Durham Teesside Hambleton Richmondshire and Whitby STP, all CCG responsibilities were part of the STP and would include all the areas the CCG were responsible for.

Q. In relation to the re-modelling of Whitby Hospital site, could the CCG perhaps clarify at the Governing Body meeting what will happen to the idea of extra care beds if NYCC feel unable to financially support the plan?  Is there a contingency plan in place in case this happens?

A. Janet Probert advised that NYCC were totally committed and the Chief Executive from Richmondshire District Council had written to the CCG advising of the changes.  The changes would be included in the CCG’s plans and shared with colleagues in the STP to ensure inclusion in future planning.  The CCG have no authority in relation to the land.

Q. The query is regarding the expected increase of personnel at Catterick Camp and whether the demand will affect the resources of HRW CCG and impact on other areas that require funding and development.

A. GP practices and the CCG’s funding allocation is based on the local population registered with GPs, so this will take account of any population increases.