Mid Essex Clinical Commissioning Group Update
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Briefing to Essex County Council HOSC – 6th January 2015 Subject: Restriction of services: Mid Essex Clinical Commissioning Group Update Date: 21st December 2015 1. Purpose of paper This paper provides members of the Essex County Council Health Overview and Scrutiny Committee (HOSC) with an update on the CCG’s current proposals to restrict four areas of local health care and the process of public consultation. 2. Background In 2014/15, Mid Essex was recognised as one of the 11 most financially challenged health economies in the country. Every year, CCG’s receive an annual budget derived from a national formula. Since forming in 2013, Mid Essex CCG has received less than its target funding. In 2014/15, MECCG received £20m (4.9%) below target funding, and in 2015/16 we are receiving £14m (3.37%) below. This puts mid Essex in the bottom 20% of all CCGs in the country in terms of distance from target funding. In reality this means that Mid Essex CCG has received approx. £1,060 per person to spend on health care in 2015/16 - about £81 per person less than other Essex CCGs. Mid Essex has a financial deficit of £24.9m set against a backdrop of increased demand on service, more complex healthcare cases and a growing population. The CCG has to make difficult decisions to ensure we can meet the health needs of the population now and in the future. 3. Our financial position As part of an agreed financial recovery plan, Mid Essex CCG has to find £15.7 million of savings this financial year. The national allocation from NHS England for next year hasn’t been received as yet, but we are expecting to have to find £13m-£15m savings in 2016/17. The CCG wants to provide health services that meet the needs of local people yet we still have to balance this with the money available. The CCG is constantly reviewing services and looking at different ways to help our communities live well and remain well. 4. Our proposals for service restrictions In the past year, Mid Essex CCG has had to make tough decisions to restrict a number of services, including IVF, as well as taking decisions on plans to transform local healthcare. These decisions have included changes to urgent care with the closure of the walk-in service and changes to how people may get care at home via Continuing Healthcare (CHC). At the Board meeting on 24 September 2015, as part of an annual review of restricted services, Members gave approval to carry out a public consultation to ask people about a further four proposals: To not routinely fund prescriptions for gluten-free foods To not routinely fund hearing aids for people with mild hearing loss To not routinely fund vasectomy and female sterilisation Options to change GP-accessed physiotherapy To not routinely fund prescriptions for gluten free food For more than 30 years, the NHS has prescribed gluten free foods like bread, flour, cereal and pasta to help people with coeliac disease follow a gluten-free diet. This policy was created at a time when gluten-free foods were not as readily available as they are today. In recent years, the range and availability of gluten- free products has increased dramatically, with most supermarkets now stocking a wide range. In January 2014, the CCG restricted prescribing of gluten-free foods to bread and flour and also reduced the number of units on prescription from 16 to 8 per month. The costs of prescribing reduced as a result of this policy, but over the last 12 months the CCG has still spent over £100,000 on gluten-free food prescriptions. Many people now suffer food intolerances and do not have the same access to subsidised products. The proposal is to stop prescription of gluten-free items altogether. To not routinely fund hearing aids for people with mild hearing loss According to data available from leading charities on hearing loss, approx 2 million people in the UK have hearing aids for all levels of hearing loss yet only 1.4 million use them regularly. Mild hearing loss is usually defined as a minimum audible sound of between 25- 40 decibels. It may result in having some difficulties keeping up with conversations, especially in noisy surroundings. Soft noises are not heard and understanding speech may be difficult in a loud environment. The proposal is to not fund hearing aids for mild hearing loss although there are groups of people who would be exempt from this (as set out in the consultation document). To not routinely fund vasectomy and female sterilisation Vasectomy and female sterilisation is considered to be one of many forms of contraception available. The number of people choosing these forms in mid Essex is very low – on average 400 men a year choose vasectomy and approx. 35 women have sterilisation. The proposal is to stop funding for vasectomy and female sterilisation Options to change GP-accessed physiotherapy Currently when someone has a musculoskeletal (MSK) pain or injury, such as a painful shoulder or knee, they visit their GP and can be referred to the community physiotherapy team. On average, patients can wait between 6 and 12 weeks to have a physiotherapy assessment and receive advice on exercise, how best to self-manage their condition or treatment. There are three options in the consultation ranging from providing a telephone only advice service for physiotherapy to limiting the service to one assessment and follow up treatment. 5. How we have arrived at these decisions Many CCGs across Essex and the UK have already taken steps to heavily restrict and ration some of the services we are considering here. The CCG’s commissioning leads have reviewed CCG decommissioning and service restriction plans across England and Wales to help guide the planning process. The CCG, therefore, has not formulated the list of service restriction ideas in isolation. All service restrictions have been clinically considered and reviewed by clinical leads in the CCG, discussed further during programme board meetings prior to presentation and agreement at the clinically led Primary Care Forum and later the Financial Recovery, Innovation and Transformation Committee. Following any implementation of these proposed restrictions, clinical reviews of the impact and benefits will be undertaken as frequently as is deemed necessary. 6. How the CCG has engaged with the public The CCG has been actively talking to the public and professionals throughout an eight week period of consultation ending on 28 December 2015. The CCG launched the consultation on 2 November 2015 by emailing the consultation document and details of how to give feedback to a wide range of stakeholders including more than 130 local organisations and groups; press and media; GP practices and patient groups; local MPs, district and parish councils. The consultation materials went live on the CCG’s website, facebook page and Twitter account and were constantly promoted throughout the eight week period. Local media including the Essex Chronicle, Braintree and Witham Times, Maldon and Burnham Standard and BBC Radio Essex gave early coverage of the consultation following launch. BBC Radio Essex devoted a day of coverage across several platforms including a public phone-in debate during its most popular and listened to shows – Breakfast and Drive Time. Social media has been well used throughout the consultation to prompt views and publicise the proposals. This promoted national media coverage in the Daily Mail online, Telegraph online and in specialist press including the Health Service Journal and the British Medical Journal. The CCG paid for adverts in three local newspaper titles to maximise publicity on the consultation workshops and in Braintree District Council’s magazine that was being delivered to all homes in the district during the period of consultation. The CCG has also been able to secure free advertising in many partner magazines and websites to widen the reach of the consultation. A number of public events took place across mid Essex to encourage people to find out more about the proposals; to allow the CCG to explain its financial position and to gather views and feedback from local people. Below is a timetable of events: Date Venue Time Wed 11 Braintree Community Centre, Hollywood, 19-21 Bocking 6pm to 7pm Nov 2015 End, Braintree, CM7 9AH Mon 16 Main Hall, Maltings Academy, Spinks Lane, Witham, CM8 6pm to 7pm Nov 2015 1EP Thurs 19 Springfield Parish Council, St Augustine’s Way, 6pm to 7pm Nov 2015 Chelmsford, CM1 6GX Mon 30 Main Hall, Maldon Town Council, Market Hill, Maldon, CM9 6pm to 7pm Nov 2015 4PZ Thur 3 St Cedds Hall, Chapter House, Cathedral Way, 6pm to 7pm Dec 2015 Chelmsford, CM1 1NX Thur 10 Champions Manor Hall (Conference Room), Hullbridge 6.30pm to Dec 2015 Road, South Woodham Ferrers, CM3 5LJ 7.30pm In addition, the CCG has held bespoke meetings with a wide variety of stakeholders to ensure we capture as many views as possible. Examples of other engagement activities: Met with local MPs to brief them directly and answer any queries or concerns Canvassed the views of more than 100 GPs in the mid Essex area during a bi-annual Summit Held 1-2-1 meetings and teleconferences with professional organisations and leading charities including: - Action on Hearing Loss - National Community Hearing Association - Chartered Society of Physiotherapists - British Academy of Audiology Held a workshop with approx. 30 local physiotherapists and physiotherapy staff working for Provide Held a workshop with approx. 20 staff from the audiology department at Mid Essex Hospital Trust Individual briefings for local district councillors with health and wellbeing portfolio Met with representatives of patient groups who helped promote to friends and peers through their network Written articles encouraging response to the consultation for CCG staff; GPs; primary care staff in practices and wider stakeholders including Healthwatch Raised the profile of the consultation at many meetings including Essex-wide communications forum; NHS England patient experience forum Responded to queries from the members of the public where required 7.