Minutes:
*O&S(E) 26
As highlighted in the Public Forum session (Minute *O&S(E) 24 above refers), Ms Fitzsimmons and Mr Clough were in attendance at this meeting to address the Committee and respond to Member questions.
In her introduction, the Chairman informed of her intention to divide this agenda item into two separate discussions. The first item would be led by Ms Fitzsimmons and would relate to the out of hours and 111 services and the second item would be introduced by Mr Clough and would specifically focus on the CCG’s Sustainability Transformation Programme
(a) The Out Of Hours and 111 Services
In her address, Ms Fitzsimmons raised the following points:-
- The 111 telephony service had been introduced with the ability of being able to offer a range of services (e.g. from calling an ambulance on behalf of the patient to offering self-care advice) whilst streamlining and simplifying the system;
- The Devon Doctors service had been commissioned to work in partnership with a national organisation called ‘Vocare’ who would provide the 111 service. Whilst the two services were working together in partnership, Ms Fitzsimmons acknowledged that there were still further improvements that could be made in this respect;
- Specifically regarding the out of hours service, approximately 60% of the contacts made were resolved through an initial telephone consultation. In the remaining instances, the Committee was informed that the GP would determine (when speaking to the patient) whether or not they believed that they would need to complete their consultation with a face to face assessment;
- Assurances were given to Members that, from the perspective of the patient, they would see no difference to the out of hours service;
- It was felt that the 111 service would result in improvements by way of advice still being given to patients whilst there would be additional Doctors and nurses involved in the process, who would be available to provide and offer faster solutions;
- Whilst there was a perception that the changes had been implemented to save money, it was in fact confirmed that the contract value was the same as before;
- The development of an integrated 111 and out of hours service was attempting to reduce the confusion around the urgent care model;
- There was now clarity around the specification for the out of hours service. This specification had been developed with the involvement of Healthwatch, with 13 GPs and 6 volunteers involved in the process. Whilst there was representation from rural areas during this process, it was acknowledged that no individuals from the West Devon area were involved. One of the conclusions reached by Healthwatch was that a reasonable travel distance to access an out of hours service was 30 minutes by car;
- It was noted that Devon Doctors had won the bid to provide the service following a competitive dialogue process. In its submission, Devon Doctors had concluded that, due to the relatively close proximity to Derriford Hospital, it could withdraw the out of hours medical cover from Tavistock. In addition, there was also the potential for patients to use the provision in both Launceston and Okehampton;
- With regard to the numbers using the Tavistock out of hours service, Members were advised that evidence suggested that, on average, less than one patient per evening was using the service during the week, with 7.3 patients utilising the service on a Saturday night and 6.6 patients on a Sunday night. As a consequence, the numbers who were impacted were not felt to be extensive and those in attendance were reminded that the Minor Injuries Unit would remain at Tavistock;
- Having sought legal advice, the CCG had concluded that there was no need for a formal consultation exercise to have been undertaken prior to this decision being made;
- It was confirmed that the CCG would monitor the changes closely and would make sure that other services were not adversely affected through these proposals;
- With regard to future challenges, Ms Fitzsimmons recognised the importance of ongoing community engagement and the need to improve understanding and communications in relation to the differences between treatment centres and minor injuries units. Finally, Devon Doctors had recognised that, on this occasion, the organisation had not adequately considered the impact of the proposed changes on their own members of staff.
In the ensuing discussion, reference was made to:-
(i) involving elected Members in the consultation process. A number of Members expressed their deep regret that Members had not been made aware of the proposals at an earlier stage. In reply, Ms Fitzsimmons accepted this point and confirmed that this had been a key lesson learned when reflecting upon this change in service provision;
(ii) the assurances received, Some Members advised that they had been comforted in the address given by Ms Fitzsimmons and wished to thank her for her informative and honest comments;
(iii) the 30 minute travel criteria. In recognising the very rural nature of West Devon and the fact that approximately 15-20% of residents did not have access to a car, Ms Fitzsimmons acknowledged that careful consideration would need to be given to these members of the community;
(iv) the cost of taxi fares. Members were advised that, in instances where a resident could not afford an expensive taxi fare, a GP home visit was likely to be prompted;
(v) the qualifications of Vocare staff. When questioned, Ms Fitzsimmons confirmed that Vocare was a national organisation, which was run to a high standard, with its pathways advisors being subject to an extensive training programme (and being regularly audited);
(vi) the use of Devon Doctors. The Committee was advised that not all GPs were happy with the changes in service provision, however Devon Doctors had now been able to fill 95% of its GP’s rotas. In addition, the main safeguard for dealing with the most vulnerable members of society was by using Devon Doctors, who knew the local community so well;
(vii) the Minor Injuries Units in Tavistock and Okehampton. In reply to a question, Ms Fitzsimmons informed that the CCG recognised that these units remained an important part of the emergency care system across the West Devon area;
(viii) the further views of Mr Eady. At her discretion, the Chairman allowed Mr Eady the opportunity to make further comments. In so doing, he stated that:
o the consultation exercise in this regard had been really poor;
o to ascertain the actual usage of the facility, there was a need to evaluate trends over a five year period;
o there was extensive future housing development proposed to be built in Tavistock; and
o on a normal day, it was often likely to take longer than 30 minutes to travel from Tavistock to Derriford.
(b) The Sustainability Transformation Programme
Following the press release during the evening of 21 September 2016 regarding the potential loss of 16 beds at the Okehampton Hospital, Mr Clough proceeded to highlight that:
- the CCG Governing Body was to determine whether or not to embark on a consultation exercise in this respect on Wednesday, 28 September 2016. The consultation would relate to future care provision in the Eastern locality of Devon and could result in a reduction of inpatient beds at some locations;
- the proposals were part of the ‘Success Regime: Case for Change’ that was published in February 2016. It was noted that the document aimed to improve health and care services for patients in response to the financial challenges that the local health and care system faced;
- subject to the outcome of the meeting on Wednesday, 28 September 2016, it was currently being recommended that four options would be presented for consultation, with the document indicating one of these as a preferred option. In terms of the format of the consultation exercise, Mr Clough advised that it was being recommended that it would run for 13 weeks from Friday, 7 October 2016, with a number of roadshows and public events being held during this period.
In discussion, the following points were raised:
(i) A number of Members expressed their deep concerns that the potential options did not currently include the retention of the beds at Okehampton Hospital as an option. Retention of the beds at Okehampton Hospital was felt to be critical for reasons including:
o there being no provision to the west of Exeter in the current range of options;
o the proposals not being developed by anyone who appreciated the local geography of the area;
o the extent of future development proposed in the Okehampton area and the current medical provision in the town already being under pressure;
o the level of local opposition that was already apparent to this proposal.
In light of the depth of feeling raised, Mr Clough gave an assurance that he would report these concerns to the meeting of the Governing Body on Wednesday, 28 September 2016.
(ii) In this instance, the Committee again reiterated that it would have been useful for local Members to have been made aware of these proposals before they had appeared in the local press and media;
(iii) There was an acceptance of the need to improve collaborative working between all relevant stakeholders and across the different CCG areas;
(iv) It was noted that the new model of care promoted greater care at home rather than patients remaining in community hospital beds;
(v) Out of courtesy to the CCG, the Leader of Council advised that a formal motion had been submitted for the upcoming Council meeting (to be held on 4 October) that was calling for the CCG to include the retention of the 16 beds as an additional option during the consultation exercise. Furthermore, it was his expectation that this motion would be supported by the Council.
In concluding the agenda item, the Chairman thanked Ms Fitzsimmons and Mr Clough for their attendance and responses to Member questions. On behalf of the Committee, the Chairman also requested that the Committee receive a further update from CCG representatives at its meeting on 7 March 2017.