Norfolk Health Overview and Scrutiny Committee Date: Thursday 4 March 2010 Time: 10.00am Venue: Edwards Room, County Hall, Norwich
Persons attending the meeting are requested to turn off mobile phones. Members of the public or interested parties who have indicated before the meeting that they wish to speak will, at the discretion of the Chairman, be given five minutes at the microphone. Others may ask to speak and this again is at the discretion of the Chairman. Membership MAIN MEMBER SUBSTITUTE MEMBER REPRESENTING Mr D Bradford Mr B Watkins Norwich City Council Mrs B A McGoun Mr ND Dixon North Norfolk District Council Mr J Bracey Mr P Balcombe Broadland District Council Mr M Carttiss Mr G Cook / Mr T Garrod / Ms Norfolk County Council D Irving Michael Chenery of Mr G Cook / Mr T Garrod / Ms Norfolk County Council Horsbrugh D Irving Mr D Harrison Mr J Joyce Norfolk County Council Mr P Hardy Mr S Little Norfolk County Council Mr S Dorrington Mr G Cook / Mr T Garrod / Ms Norfolk County Council D Irving Mr J Labouchere Mr R Kybird Breckland District Council Dr N Legg Mrs C Stevens South Norfolk District Council Mr J Perry-Warnes Mr G Cook / Mr T Garrod / Ms Norfolk County Council D Irving Mr G Sandell Mr C Walters Kings Lynn and West Norfolk Borough Council Mrs J Chamberlin Mr G Cook / Mr T Garrod / Ms Norfolk County Council D Irving Mrs S Weymouth Ms P E Page Great Yarmouth Borough Council Mr AJ Wright Mr G Cook / Mr T Garrod / Ms Norfolk County Council D Irving For further details and general enquiries about this Agenda please contact the Committee Administrator: Tim Shaw on 01603 222948 or email [email protected] Norfolk Health Overview and Scrutiny Committee – 4 March 2010
1. To receive apologies and details of any substitute members attending
2. Glossary of Terms and Abbreviations
Terms and abbreviations used in the agenda papers. (Page )
3. Minutes
To confirm the minutes of the meeting of the Norfolk Health (Page ) Overview and Scrutiny Committee held on 21 January 2010.
4. Members to Declare any Interests
Please indicate whether the interest is a personal one only or one which is prejudicial. A declaration of a personal interest should indicate the nature of the interest and the agenda item to which it relates. In the case of a personal interest, the member may speak and vote on the matter. Please note that if you are exempt from declaring a personal interest because it arises solely from your position on a body to which you were nominated by the County Council or a body exercising functions of a public nature (e.g. another local authority), you need only declare your interest if and when you intend to speak on a matter.
If a prejudicial interest is declared, the member should withdraw from the room whilst the matter is discussed unless members of the public are allowed to make representations, give evidence or answer questions about the matter, in which case you may attend the meeting for that purpose. You must immediately leave the room when you have finished or the meeting decides you have finished, if earlier. These declarations apply to all those members present, whether the member is part of the meeting, attending to speak as a local member on an item or simply observing the meeting from the public seating area.
5. To receive any items of business which the Chairman decides should be considered as a matter of urgency
6. Chairman’s Announcements
Meeting with NHS Norfolk Non-Executive Director and Senior Managers on 29 March 2010.
7. Changes to NHS Provided Respite Services for Adults with Learning Difficulties (Page ) The Committee will respond to the Joint Commissioners’ (Adult Social Services and NHS Norfolk) proposals for re-provision of respite services, which are currently provided by the NHS at 3 Mill Close, Aylsham and 3 Park View, King’s Lynn.
2 Norfolk Health Overview and Scrutiny Committee – 4 March 2010
8. Diabetes – Children’s Services and Foot and Eye Screening Services Response from the NHS and Norfolk County Council Children’s Services to the Working Group report and recommendations (Page ) endorsed by the Committee on 15 October 2009.
11:45 – 11:55 Break at the Chairman’s discretion
9. Changes to local NHS Continuing Healthcare Policy
To respond to a consultation from NHS Norfolk and NHS Great Yarmouth and Waveney on a new draft policy for provision of NHS Item withdrawn Continuing Healthcare to adults.
10. Costessey Medical Practice Relocation
An information report from NHS Norfolk. (Page )
11. Forward Work Programme
To consider and agree the Committee’s forward work programme. (Page )
Chris Walton Head of Democratic Services
County Hall Martineau Lane Norwich NR1 2DH
Date Agenda Published: 24 February 2009
Main Committee Members have a formal link with the following local NHS Trusts:
Mr A Wright – NHS Norfolk (PCT) Mr G Sandell and Mr A Wright – Queen Elizabeth Hospital, King’s Lynn NHS Trust Mr J Bracey – Norfolk and Waveney Mental Health NHS Foundation Trust. Mrs S Weymouth – NHS Great Yarmouth and Waveney (PCT). Dr N Legg – Norfolk and Norwich University Hospital NHS Foundation Trust Mr M Carttiss and Mrs S Weymouth – James Paget University Hospital NHS Foundation Trust
3 Norfolk Health Overview and Scrutiny Committee – 4 March 2010
NORFOLK HEALTH OVERVIEW AND SCRUTINY COMMITTEE PROGRAMME OF FUTURE MEETINGS
15 April 2010 15 July 2010 27 May 2010 2 September 2010
If you need this Agenda in large print, audio, Braille, alternative format or in a different language please contact Tim Shaw on 0344 800 8020 or Textphone 0344 800 8011 and we will do our best to help.
4
NORFOLK HEALTH OVERVIEW AND SCRUTINY COMMITTEE MINUTES OF THE MEETING HELD ON 21 JANUARY 2010
Present:
Mr M R H Carttiss (Chairman), Norfolk County Council Michael Chenery of Horsbrugh Norfolk County Council Mr J Bracey Broadland District Council Mr D Bradford Norwich City Council Mrs J Chamberlin Norfolk County Council Mr S Dorrington Norfolk County Council Mr D Harrison Norfolk County Council Mr J Labouchere Breckland District Council Dr N Legg South Norfolk District Council Mrs B A McGoun North Norfolk District Council Mr J Perry-Warnes Norfolk County Council Mrs S Weymouth Great Yarmouth Borough Council Mr A J Wright Norfolk County Council
Also Present:
Jim Barker Programme Manager (Unplanned Care), NHS Norfolk Anne Osborn Director of Strategy, Planning and Performance, Norfolk and Norwich University Hospitals NHS Foundation Trust Roger Hadingham Commissioning Officer, Adult Social Services David Stonehouse Deputy Chief Executive and Director of Finance, NHS Norfolk Tim O’Mullane Head of Learning Difficulties Services, Adult Social Services Bob Mee Interim Director of Learning Difficulties, NHS Norfolk Paul Steward Consultant Project Manager for Changes to NHS Provided Respite Services for Adults with Learning Difficulties Julie Cave Director of Resources, Norfolk and Norwich University Hospitals NHS Foundation Trust Krishna Sethia Consultant Urologist, Norfolk and Norwich University Hospitals NHS Foundation Trust Michele Nash Chairman, Cromer Hospital Action Group Hilary Thompson County Councillor for Cromer Patrick Thompson Norfolk LINk Mary Ledgard Norfolk LINk David Russell Norfolk LINk Helen Lloyd Norfolk and Norwich University Hospitals NHS Foundation Trust Ellis Laywood Audit Commission Sandra Meaden Norfolk and Norwich University Hospitals NHS Foundation Trust Lyn Reynolds East of England Ambulance Service James Joyce Norfolk County Councillor 1 Chris Humphris NHS Great Yarmouth and Waveney Maureen Orr Scrutiny Support Manager (Health) Chris Walton Head of Democratic Services Tim Shaw Committee Officer
(For ease of reference, items are recorded in these minutes in the order in which they appear on the agenda. This is not necessarily the order in which the items were considered at the meeting).
1 Apologies for Absence
1.1 Apologies for absence were received from Mr P Hardy and Mr G Sandell.
2 Glossary of Terms and Abbreviations
2.1 Members received a glossary of the terms and abbreviations used in the agenda papers. They also received on the table an explanation of the different medical procedures that were used in endoscopy (for use at item 7, when considering the report on the redevelopment of Cromer Hospital).
3 Minutes
3.1 The minutes of the previous meeting held on 26 November 2009 were confirmed by the Committee and signed by the Chairman.
4 Declarations of Interest
4.1 Michael Chenery of Horsbrugh declared a personal interest in the item about the response to the draft dementia strategy because he had a substantive contract with the Norfolk and Waveney Mental Health NHS Foundation Trust and he was also a Mental Health Practitioner.
4.2 Steve Dorrington declared a personal interest in the item about the draft dementia strategy consultation and the item about changes to NHS provided respite services for adults with learning difficulties because he was a care home provider.
4.3 John Perry-Warnes declared a personal interest in the item about the redevelopment of Cromer Hospital because he was a Member of the Friends of Kelling Hospital.
5 Urgent Business
5.1 There were no items of urgent business.
6 Chairman’s Announcements
6.1 (a) Change of Membership
The Chairman welcomed back to the Committee Mrs Jenny Chamberlin in place of Mrs Alison Thomas who had become Deputy Cabinet Member for Vulnerable Children.
2 6.2 (b) Change of Agenda Order: Cromer Hospital Redevelopment
The Committee agreed to a suggestion from the Chairman to consider urgent and emergency services in Norfolk as the first substantive item on this agenda and delay consideration of the item on Cromer Hospital redevelopment until after 11am when Krishna Sethia, Consultant Urologist at the Norfolk and Norwich University Hospitals NHS Foundation Trust would be able to attend the meeting.
The Chairman said that in the interests of all those who attended the Committee’s meetings it was important for Members to be able to consider items in the order in which they appeared on the agenda. In future he would be unlikely to put forward changes in the agenda order after the papers had been published. The agenda order was agreed with NHS witnesses at least some two weeks before the day of the meeting and that was the time for us to be advised if the proposed timing was inconvenient.
6.3 (c) Meeting with Non-Executive Directors and Managers of NHS Norfolk
It was noted that the date for the meeting with NHS Norfolk Non-Executive Directors and Managers had been changed from 4 February 2010 to 29 March 2010. This meeting would be held in the Edwards Room at County Hall and details sent to Members in due course.
6.4 (d) Norfolk LINk
The Chairman said that Norfolk LINk had invited the Committee to appoint a Member to join one of Norfolk LINk’s regular meetings of its Older People with Mental Health Problems Working Group. The Committee nominated Shirley Weymouth to attend the Norfolk LINk Working Group and Michael Chenery of Horsbrugh to be her named substitute.
7 Cromer Hospital Redevelopment
7.1 The Committee received a suggested approach from Maureen Orr, Scrutiny Support Manager (Health), to a report from the Norfolk and Norwich University Hospitals NHS Foundation Trust that set out the results of its consultation on plans to redevelop Cromer Hospital and the recommendations that were due to go to its Board on 22 January 2010. The Committee also received additional information from Norfolk LINk (that had been sent to Members in advance of the meeting) that set out Norfolk LINk’s comments on the redevelopment proposals and the public consultation exercise.
7.2 The Committee received evidence from the following witnesses:
Julie Cave, Director of Resources, Norfolk and Norwich University Hospitals NHS FT Krishna Sethia, Consultant Urologist, Norfolk and Norwich University Hospitals NHS FT Michele Nash, Chairman, Cromer Hospital Action Group Hilary Thompson, County Councillor for Cromer John Perry-Warnes, Committee Member and County Councillor for Holt Patrick Thompson, Norfolk LINk.
3 7.3 In hearing from the witnesses and in answer to Members’ questions, the Committee noted the following:
The witnesses said that development work at Cromer hospital was due to start on site by the beginning of July 2010 and finish in 2012.
The Cromer Hospital project made maximum benefit out of the generous legacies left to Cromer hospital by Sagle Bernstein and Phyllis Cox. The NNUH had agreed to commit the £15m legacy to the development of the new hospital and had set aside a small contingency reserve. It would cost an additional £3m from the NHS to provide endoscopy at Cromer and this was too expensive for the NHS to include within the budget for the Cromer hospital project.
The service model for the new Cromer hospital was aimed at providing mainly “high volume, high frequency services that had a low clinical risk”. Such services excluded general anaesthetic surgery and endoscopy which were being relocated at the NNUH.
To provide an acute endoscopy unit at Cromer Hospital would require 700 square metres in order to meet hygiene requirements and the decontamination regulations.
A new MRI scanner at Cromer hospital would deal with up to 4,000 patients a year.
The 18 week treatment time target applied at Cromer Hospital as it did elsewhere.
The witnesses said the NNUH would be able to cope with the additional numbers of patients transferring from Cromer Hospital.
Members pointed out that there were potential transport difficulties for patients who currently attended Cromer Hospital who would have to attend the NNUH some 25 miles away.
Some Members said those living in Cromer were fortunate to have a new hospital being build in their area because nothing similar existed for those living in the south of the county, and for whom a 25 mile journey to the NNUH was usual.
In response to a question from John Perry-Warnes, local County Councillor for Holt and a Member of the Committee, Krishna Sethia, Consultant Urologist, NNUH, said that there were no known difficulties with clinicians having to travel daily to Norwich.
Michele Nash, Chairman of the Cromer Hospital Action Group, said that whilst some people were disappointed with some aspects of the redevelopment plan, most people she had spoken with had broadly supported what was being proposed. It might be possible for funds to be raised locally for keeping endoscopy at Cromer. Detailed discussions with the NNUH about the types of services that could be provided in the hospital were continuing. These discussions included the possibility of a GP practice being sited within 4 the hospital grounds.
Hilary Thompson, the local County Councillor for Cromer, said that the public consultation about the proposed new hospital had been generally well received in the locality although disappointment remained that there would be on endoscopy unit . She said that it was important there was no delay in the implementation of the project. There was a danger that any delay in approval could result in the loss of some services, given the poor state of public finances.
Patrick Thompson, Norfolk LINk, said that Members of Norfolk LINk had visited a GP surgery where endoscopy was performed. He said that Norfolk LINk remained concerned about the lack of detail concerning the facilities that would be provided in the new building.
7.4 The Committee agreed that –
(a) The NNUH consultation with the Committee had been adequate.
(b) The NNUH proposals were in the interests of the local Health Service. The Committee requested the NNUH continue to work closely with the Cromer Hospital Action Group and the NNUH respond favourably if, in the years ahead, local fundraisers were able to raise enough money to support an endoscopy service at the hospital that met all the relevant healthcare standards.
8 Response to the Draft Dementia Strategy Consultation
8.1 The Committee received a report from Maureen Orr, Scrutiny Support Manager (Health), that asked Members to agree a response to a draft joint commissioning strategy from NHS Norfolk, NHS Great Yarmouth and Waveney and Norfolk County Council’s Adult Social Services Department, entitled “Living Well with Dementia: Transforming the Quality and Experience of Dementia Care for the People of Norfolk”.
8.2 The Committee received evidence from the following witnesses:
Roger Hadingham, Commissioning Officer, Adult Social Services David Stonehouse, Deputy Chief Executive and Director of Finance, NHS Norfolk.
8.3 During discussion, it was suggested that the joint commissioners should be asked to respond in writing to the Committee’s comments and questions that could be found at paragraph 2.2 of the report. It was also suggested that the response of the joint commissioners should be shared with Members of the Committee.
8.4 The Committee endorsed the response at paragraph 2.2 of the report, subject to the addition of a comment seeking information from the joint commissioners about those who would diagnose dementia.
9 Proposed Changes to NHS Provided Respite Services for Adults with Learning Difficulties: 3 Mill Close, Aylsham and 4 Park View, King’s Lynn
9.1 The Committee received a suggested approach from Maureen Orr, Scrutiny Support Manager (Health), to a report from the Pooled Fund Commissioners 5 (NHS Norfolk, NHS Great Yarmouth and Waveney and Norfolk County Council) on proposals to discontinue NHS provided respite care for adults with learning difficulties at 3 Mill Close, Aylsham and 4 Park View, King’s Lynn.
9.2 The Committee received evidence from the following witnesses:
Tim O’Mullane, Head of Learning Difficulties Services, Adult Social Services Bob Mee, Interim Director of Learning Difficulties, NHS Norfolk Paul Steward, Consultant Project Manager.
9.3 It was noted that the Committee had previously examined the proposed changes in respite services for adults with learning difficulties at its meeting in September 2009 and that Members were due to receive a full consultation report about the proposals in March 2010. It was pointed out that this report would include detailed proposals on alternatives to the current NHS provided respite service, and explain the likely financial implications of each of the proposals for all parties.
9.4 It was pointed out that those living in the east of the county and currently receiving respite care at Mill Close would have their respite care re-provided with those moving from Lothingland to a new facility at Pinewoods at Repps with Bastwick. The existing facilities would not close until the planned care was operational, in around June 2010.
9.5 The Committee noted the progress report. The Committee agreed that parent/carer representatives should be invited to the March 2010 meeting when the Pooled Fund Commissioners would present their full consultation report. The Committee asked for the report to include information on how charges were to be introduced for parent/carer representatives, and the overall cost implications for the NHS, Adult Social Services and the individuals concerned.
10 Urgent and Emergency Services in Norfolk
10.1 The Committee received a suggested approach from Maureen Orr, Scrutiny Support Manager (Health), to a report from NHS Norfolk about urgent and emergency health service strategies in light of the rise in emergency admissions to hospital.
10.2 The Committee received evidence from the following witnesses:
Jim Barker, Programme Manager (Unplanned Care), NHS Norfolk Anne Osborn, Director of Strategy, Planning and Performance, Norfolk and Norwich University Hospitals NHS FT.
10.3 It was noted that Dr Bryan Heap, Medical Director and Chairman of Unplanned Care Programme Board, NHS Norfolk, had intended to attend the meeting but had given his apologies due to illness. The Committee agreed to consider the rise in emergency admissions to hospital at this meeting in Dr Heap’s absence, and examine the measures that the NHS was taking to address the current situation at the March 2010 meeting when Dr Heap would be able to respond to any questions from Members.
10.4 In hearing from the witnesses and in answer to Members’ questions, the Committee noted the following:
6 It was pointed out that there had been a 16% rise in medical emergency admissions and an 11% rise in A&E attendances at the NNUH in the past year and that there had been a rise in demand for emergency services at the Queen Elizabeth Hospital and the James Paget Hospital, but not to the same extent.
The rise in emergency admissions was attributed to an increase in self- referrals, inadequacies in the provision of primary care, particularly out-of- hours services, and a perceived difficulty in obtaining GP appointments, particularly amongst migrants living in the west of the county who were unfamiliar with the working of the NHS.
It was pointed out that there was a strong relationship between the NHS and migrant workers in the Great Yarmouth area and there could be lessons to be learned from this in the NHS Norfolk area.
Emergency admissions increased pressures on the four-hour waiting target.
An Emergency Care Intensive Support Team had been set up to look at care pathways and to make best practice recommendations for reducing demand on hospital services.
A social marketing “Choose Well” campaign had been launched by NHS Norfolk to ensure people attended the right kind of health service for their treatment and did not go to A&E departments unnecessarily.
Patients with minor ailments who went to the A&E department were being encouraged to see their GP or pharmacist instead. This approach to managing attendance at A&E was being piloted at the Queen Elizabeth Hospital. The pilot was in its infancy and it was hoped to roll it out across Norfolk in due course.
The initiative taken in setting up the Walk-in Centre at Timberhill in Norwich was meant to ease the pressures on the A&E department at the NNUH.
It was important people only accessed emergency help or treatment if it was indeed an emergency. Various other NHS services such as GP surgeries and NHS Direct were available so that people could choose the right service for their ailment.
It was considered important for information about how people could access NHS services to go out in different languages and be made available in places where migrant workers were most likely to read it. This was not necessarily in GP practices.
Patrick Thompson, Norfolk LINk, spoke about the importance of A&E services being “user friendly” and more easily understood by the public.
10.5 The Committee asked for representatives of NHS Norfolk and NHS Great Yarmouth and the NHS hospital acute trusts to give a further report at a later meeting.
7 11 Appointment to Great Yarmouth and Waveney Joint Health Scrutiny Committee
11.1 The Committee received a report that sought approval to fill a vacancy for a Conservative Member on the Great Yarmouth and Waveney Joint Health Scrutiny Committee in place of Mrs A Thomas.
11.2 The Committee agreed to appoint Michael Chenery of Horsbrugh to fill that vacancy.
12 Information for the Care Quality Commission
12.1 The Committee received a report by Maureen Orr, Scrutiny Support Manager (Health), that sought approval to a method for providing information to the Care Quality Commission.
12.2 Steve Dorrington reported on a meeting that he and Members from local authorities across the south east had attended with representatives from the Care Quality Commission to consider how the Care Quality Commission would regulate all health and social care services in England, whether they were provided by the NHS, local authorities or private companies. He said that the Care Quality Commission had suggested each Health Overview and Scrutiny Committee should appoint a Member Champion for Care Quality issues..
12.3 The Committee agreed to accept an invitation from Norfolk LINk to join it in a workday with the Care Quality Commission, to be held locally.
12.4 The Committee also agreed that –
(a) In-depth scrutiny reports approved by the Committee should be routinely copied to the Care Quality Commission for information.
(b) At the request of the Care Quality Commission, persistent issues that were not being resolved locally would be brought to it’s attention. (It was, however, noted that by the time such issues became “persistent” the Committee was more than likely to be following other routes of redress).
13 Regional Joint Health Scrutiny Committees
13.1 The Committee received a report from Maureen Orr, Scrutiny Support Manager (Health), that asked the Committee to waive the requirement for political proportionality on regional and sub-regional Joint Health Scrutiny Committees which were formed on a task and finish basis.
13.2 It was agreed that –
(a) Other authorities participating in future regional and sub-regional Joint Health Scrutiny Committees may waive rules on political balance when appointing Members to Joint Committees.
(b) The Committee’s own appointments to Joint Committees will be according to the political balance of Norfolk County Council, unless the Council approves otherwise.
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14 Forward Work Programme
14.1 The Committee agreed the Forward Work Programme that was set out in the report subject to the following amendments:
(a) NHS Norfolk and NHS Great Yarmouth and Waveney consultation on Continuing Healthcare Policy to be received at the 4 March 2010 meeting.
(b) “Urgent and emergency care” to be added to the 4 March 2010 agenda.
(c) “How we manage death and dying“ to be postponed from 4 March 2010 to the 15 April 2010 meeting.
The meeting concluded at 13.15pm
CHAIRMAN
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T:\Democratic Services\Committee Team\Committees\Norfolk Health Overview & Scrutiny Committee\Minutes\Final\ NHOSC Mins 100121
9 Norfolk Health Overview and Scrutiny Committee 4 March 2010 Item 2
Glossary of Terms and Abbreviations
ADHD Attention deficit hyperactivity disorder CHC Continuing Healthcare CQC Care Quality Commission CAF Common Assessment Framework CAMHS Child and Adolescent Mental Health Services CAU Children’s Assessment Unit CCNT Children’s Community Nursing Team CS Children’s Services – Norfolk County Council department DAFNE Dose adjustment for normal eating DESMOND Diabetes education and self management for ongoing and newly diagnosed DNAs Do Not Attends FST Family Solutions Team GP General Practitioner GY&W NHS Great Yarmouth and Waveney (Primary Care Trust) GY&W JHSC Great Yarmouth and Waveney Joint Health Scrutiny Committee (which includes Members from Norfolk and Suffolk Health Overview and Scrutiny Committees) HCA Health Care Assistant HOSC (OSC) Health Overview and Scrutiny Committee IFRP Individual Funding Request Panel JPUH James Paget University Hospital NHS Foundation Trust KiWi Kings Lynn & Wisbech Diabetes UK Support Group LINk Local Involvement Network NCH&C Norfolk Community Health and Care NHOSC Norfolk Health Overview and Scrutiny Committee NHS National Health Service NHS GY&W NHS Great Yarmouth and Waveney (Primary Care Trust) NHS N NHS Norfolk (Primary Care Trust) NICE National Institute for Health and Clinical Excellence NLDS Norfolk Learning Difficulty Service NNUH Norfolk and Norwich University Hospital NHS Foundation Trust PDSN Paediatric Diabetes Specialist Nurse PbC Practice-based Commissioning PCT Primary Care Trust QEH The Queen Elizabeth Hospital NHS Trust, King’s Lynn QOF Quality Outcomes Framework RAT Rapid Action Team SENCO Special Educational Needs Co-ordinator UEA University of East Anglia WTE Whole Time Equivalent
Norfolk Health Overview and Scrutiny Committee 4 March 2010 Item no 7
Proposed Changes to NHS Provided Respite Services for Adults with Learning Difficulties 3 Mill Close, Aylsham and 4 Park View, King’s Lynn (now relocated to 3 Park View)
Report by the Pooled Fund Commissioners
Suggested approach from Maureen Orr, Scrutiny Support Manager
Report from the Pooled Fund Commissioners (NHS Norfolk, NHS Great Yarmouth and Waveney and Norfolk County Council) regarding proposals to discontinue NHS provided respite care for adults with learning difficulties at 3 Mill Close, Aylsham and 4 Park View, King’s Lynn (now relocated to 3 Park View) and re-provide the service in different ways. The Committee is asked to respond to the commissioners’ proposed alternatives for provision of respite services.
1. Background
1.1 In September 2009 the Committee was notified of the Pooled Fund Commissioners’ proposals to discontinue NHS provided respite care at 3 Mill Close, Aylsham and 4 Park View, King’s Lynn as a result of the NHS Campus Closure project, which involves closure of all NHS residential campuses for adults with learning difficulties. The residential Campus Closure project means that the NHS will no longer be in a position to directly provide respite care to adults with learning difficulties.
1.2 The Committee agreed that the proposed changes in the method of provision were a substantial variation of service under the Health and Social Care Act 2001 and asked the Pooled Fund Commissioners to consult it when they had specific, detailed proposals for alternative provision of respite services.
1.3 The Pooled Fund Commissioners reported on progress in January 2010, when the Committee was informed that 4 Park View, King’s Lynn, had closed. People who had received respite there were continuing to receive the service at 3 Park View. All of the Park View bungalows are due to close under the NHS Campus Closure project.
1.4 The Committee also heard that following assessment of the people currently using respite beds at Mill Close and Park View it is anticipated that all of them will continue to require a bed based service. Individuals were assessed against five provisional levels of respite service. One included health care interventions alongside social care and the other four included no health care element but were a mixture of social care, bed-based placements with families and non bed-based respite options. 40% of the individuals currently using 3 Mill Close and 3 Park View were assessed as requiring a service with a health care element.
1.5 The Pooled Fund Commissioners also reported legal advice on the introduction of client contributions to Social Services respite. They have been advised that charging can be introduced provided that they have acted reasonably. Respite services have previously been provided free of charge to this client group by the NHS.
2. Purpose of today’s meeting
2.1 The Committee will receive a report from the Pooled Fund Commissioners that sets out details of how they propose to re-provide respite services for adults with learning difficulties, including the financial implications of the proposals for all concerned. Their report is attached at Appendix A.
2.2 The Pooled Fund Commissioners will be present to answer Members’ questions. Representatives of the families currently using the services at 3 Mill Close and 3 Park View have also been invited to give their views at the meeting. All of the parent/carers concerned have been notified about the meeting and invited to give written comments, if they wish. The comments received are included at Appendix B.
2.3 The Committee will then be invited to give its formal response to the Pooled Fund Commissioners’ consultation.
3. The Committee’s Role
3.1 Usually when a local Health Overview and Scrutiny Committee is consulted about a proposed change to local health services the impetus for the change has come from the local NHS. This case is different because the need to change local respite arrangements has been precipitated by a national drive to close the NHS residential campuses in which they are currently provided. As the Pooled Fund Commissioners explained in their report to Committee on 3 September 2009, the government’s policy aim is for people not to live in NHS facilities. The ambition to close all of the NHS residences means that these facilities and their staff will no longer be available to provide short-term respite care and alternative provision needs to be found.
3.2 At the end of a consultation process the Health Overview and Scrutiny Committee’s role is to consider two questions:-
(a) Has the consultation with the Committee been adequate? (b) Are the proposals in the interests of the local health service?
If the answer to either of the questions is ‘no’ then the Committee can consider referring the matter to the Secretary of State for Health for review.
In this case the Committee needs to be clear about what it is considering under (b). This consultation is not about the closure of the NHS residential facilities, which is driven by national policy. It is about the adequacy of the re-provision of respite services that local commissioners are arranging for when the residential facilities close.
3.3 The Committee’s focus should be on whether the commissioners are proposing adequate arrangements for all current and future patients; it cannot pursue individual cases in detail.
4. Suggested approach
4.1 Members may wish to question the commissioners on the following areas:-
(a) The report to the Committee in January 2010 identified that all or nearly all of the people currently receiving respite at 3 Mill Close and 3 Park View will continue to need bed based respite. Can the commissioners clarify the respite bed capacity in their re-provision proposals and how it compares to current bed capacity?
(b) Can the commissioners clarify whether the amount of bed-based respite time offered to individuals in these proposals is equivalent to the amount they currently receive?
(c) How do the commissioners propose to arrange for the occasional healthcare interventions that will be required by approximately 40% of people using the service?
(d) The commissioners’ report says ‘Given that the people currently using 3 Mill Close and 3 Park View have historically received respite ‘free of charge’ NHS Norfolk is ‘currently looking into options to resolve the issue of financial contributions so that no financial charges are imposed once alternative respite is in place.’ What will the position be for future users of the respite service?
(e) Are people who need health care interventions during a period of respite care actually receiving a health service or a social care service and what difference does this make to potential charging?
(f) The report to the Committee in January 2010 mentioned that the legal advice is that charges may be levied for social services respite for this client group provided the commissioners have acted reasonably. What do the commissioners and patient/carers think the lawyers mean by ‘acted reasonably’? Does the test of ‘reasonableness’ apply to the size of the charge that people may be asked to pay?
(g) How will the needs of future patients be assessed and provided for?
4.2 The Committee could then decide:-
(a) Has the Pooled Fund Commissioners’ consultation with the Committee been adequate?
(b) Are the Pooled Fund Commissioners’ proposals adequate for re- provision of respite care to adults with learning difficulties?
In considering (b) the Committee can consider whether the Pooled Fund Commissioners have consulted adequately with the people affected by these proposals and other stakeholders who may be able to represent this client group’s interests.
The Committee may also add any other comments that it wishes the Pooled Fund Commissioners to take into account.
If you need this report in large print, audio, Braille, alternative format or in a different language please contact Maureen Orr on 0344 800 8011 or 0344 800 8011 (Textphone) and we will do our best to help.
Appendix A
Norfolk Health Overview and Scrutiny Committee 4 March 2010
Changes to NHS Provided Respite Care Services
Report by the Director of Adult Social Services and Chief Executive of NHS Norfolk.
This paper provides a report on the proposed changes to NHS provided respite care services for adults with a learning difficulty in Norfolk. The report follows the progress report presented to members of this committee on the 21 January 2010
1 Introduction
1.1 The background and context, together with the desired outcomes of the Respite Care Project was reported to the Norfolk Health Overview and Scrutiny Committee on 3 September 2009.
1.2 A progress report was submitted to the Committee on 21 January 2010
1.3 The Respite Care Project was established to re-provide person centred respite care that meets the needs of adults with a learning difficulty and their families and carers using the respite bungalow at 3 Mill Close, Alysham and the one respite bed at 3 Park View, King’s Lynn. This report provides the Committee with information on the planned re-provision of these services.
2 Current respite care service at 3 Mill Close and 4 Park View
2.1 Norfolk Community Health and Care (NCHC) provide bed based respite care for adults with a learning difficulty in two bungalow facilities at Aylsham and King’s Lynn respectively. The largest of the two respite facilities is 3, Mill Close, Aylsham, a detached bungalow where all five respite beds are currently used by 30 families from across Norfolk. The smaller respite facility is number 3, Park View, King’s Lynn, (moved from number 4) a residential bungalow, providing 1 bed as the respite bed currently used by 4 families living in the west of the County.
2.2 The service provides planned specialist respite care by nurses and other health staff to give families and carers a break.
2.3 The King’s Lynn families can access up to 28 days respite per family, per year at 3 Park View. The use of 3 Mill Close depends upon the complexity of need and family circumstances with a range from 8 nights per year being the lowest and 92 nights per year being the highest.
2.4 The project seeks to have in place a range of respite options that will meet the needs of the adults with a learning difficulty currently receiving respite care at 3, Mill Close and 3, Park View once the campus closure programme is complete.
2.5 At present both Mill Close and Park View continues to operate on a “business as usual “basis providing regular respite care to family carers.
3 Current Project Position
3.1 All assessments of people who currently use 3 Mill Close and 3 Park View have been completed in order to assess individual levels of need.,
3.2 An assessment and scoring process has been developed in order to define levels of need into 4 different levels. These levels range from level 1 for people with very high complex needs who will require occasional health interventions to level 4 where peoples’ needs are less complex and they require little or no direct health input. This process has been developed to help us effectively plan what individual needs are for this group of people and where we may need to develop or commission new services.
3.3 Of the 34 people who currently use Mill Close and Park View 80% have been assessed as having either level 1 or level 2 needs. These are high level needs which can be met in a variety of different ways including “bed based respite”. The term “bed based” however can be misleading as the need is for a “break away from the family home” and this can be provided by the Shared Lives Scheme, via Direct Payments to stay with a relative or friend, going for a short break with appropriate support as well as being provided in a dedicated respite care building or unit.
3.4 The project to re-provide NCHC respite services is now included in NLDS’s Draft Respite Care Business Plan 2010/2014 which shapes the provision of respite services for the next three to four years. At the heart of this plan is the principle of people having access to a range of different options and a menu of respite alternatives to choose from as outlined in 3.3 above.
3.5 A Fair Allocation Tool has been developed to assess the amount of respite care the person using the service will need based upon personal family circumstances, with the amount of respite determined on an individual case
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by case basis.
4 Next Steps
4.1 Officers will share all assessments and supporting information with parents and carers and agree future respite arrangements to meet the needs of the person with the learning difficulty and the break from caring that the families and carers need.
4.2 The process will be person centred and not service driven with the principle of tailoring individual planned respite care from a menu of respite options. It is acknowledged that a ‘bed based’ service will be required for a number of people with complex needs, but this will be as flexible as possible with arrangements for health interventions included in respite care as part of comprehensive support and care plans.
4.3 In order to ensure a personalised approach and the likelihood that some service development will be required it is anticipated that current NHS respite care provided services will remain open well into the first quarter of the new financial year 2010/11
4.4 The position remains that current respite services provided at Mill Close will remain in place until alternative options have been agreed and are put into place.
5 Project management and engagement
5.1 The Parent and Carer Support Groups continue to meet on a monthly basis and feedback from these groups have been positive and parent carers have said that they are kept well informed and involved in this process.
5.2 The Project Management Group also meets regularly and includes parent carer membership to ensure complete transparency.
5.3 A regular newsletter gives parents and carers up to date information and invites feedback on what will be the implementation phase of the project.
5.4 A letter has been sent to parents and carers giving feedback from the HOSC meeting held on 21 January 2010 and they have been invited to attend today’s meeting and to contribute feedback and give their opinion and views as part of involvement in the formal consultation process.
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6 Financial Implications
6.1 Given that the people currently using 3 Mill Close and 3 Park View have historically received respite care ‘free of charge’ NHS Norfolk are currently looking into options to resolve the issue of financial contributions so that no financial charges are imposed once alternative respite is in place.
7 Recommendations
7.1 Members of the Health Overview and Scrutiny Committee are invited to comment on the Respite Care Project.
Officer Contacts: Bob Mee, Interim Director of Learning Disabilities, Norfolk Community Health Care. Tim O’Mullane, Head of Service, Norfolk Adult Social Services. Paul Steward, Independent Consultant.
4
Appendix B
A Statement for Norfolk Health Overview and Scrutiny Committee from the parents of someone who receives respite at 3 Mill Close
Following the letter dated 5th February, 2010 about Respite Provision at 3 Mill Close Aylsham we are writing to make you aware of our family situation. .
2 of our children, a sister and brother, have severe learning difficulties. Our daughter receives respite at 3, Mill Close and we are very concerned about future provision for her and others like her. When our daughter is at respite we need to feel confident that she is receiving specialist care from highly trained staff that would not panic if the unexpected occurs. Our daughter used to receive respite at Quidenham Hospice and when she became too old to access this high level hospice type care we looked at all sorts of respite provision for her and the only place that could fill her needs entirely was 3, Mill Close.
Our son is also classed as severely disabled but his needs are based around his ADHD and his behaviour. He receives Social Services respite and the respite he receives is very different from the highly specialised care and environment that our daughter requires.
Our daughter is profoundly disabled and is totally dependant on others for all of her needs. She is epileptic and has multiple seizures every day. Our daughter is fed by a tube bypassing her stomach and directly into her bowel – her feeding and medication regime is very complex and needs constant monitoring. The reason she is fed into her bowel is because any food that goes into her stomach tips over and goes into her lungs. If our daughter is not positioned correctly this can still happen with stomach bile and she will turn blue frequently. Our daughter is pump fed for 18 out of 24 hours with just two 4 hourly breaks – she is fed overnight and needs constant monitoring and turning. She needs provision with specialised waking night staff.
As our daughter is fed entirely on liquids and is doubly incontinent some of her everyday care is not pleasant. She needs to be cared for by staff that is trained and willing to undertake this sort of task.
While our daughter is at respite we do not go away but take the opportunity to have a break from constant care. We experience uninterrupted sleep and the enjoy opportunity to spend some time with our other children. Direct payments would be of no advantage to us as we are not comfortable having carers in our home and we would be unable to purchase the specialised service that our daughter requires. It is very rare that both our disabled children are at their respite provision together and our son would not be able to cope with strangers coming into our home to provide care for our daughter. Our bungalow has been adapted for our daughter, she has overhead tracking and specialised equipment for bathing, toileting and all of her needs this rules out a family placement as she needs to be in an adapted single level environment.
As I mentioned above our son receives Social Services respite. There is no waking night staff, no bath and accommodation is on 2 levels. The rooms are small, there would be no room for a hoist, the corridors are small and I doubt you would even be able to get our daughters specialist wheelchair in through the entrance. There is no specialised equipment and the staffing levels especially at night would not be sufficient. The clients using the Social Services respite facility are much more able and the respite provided involves lots of noise, activities and outings – none of which would be suitable for our daughter.
The Social Services facility in which our son receives respite is always booked solidly a year in advance and for the past 2 years our son has not received his respite allocation because there were not enough spaces so it is difficult to imagine how they would cope if they had more clients, especially clients who needed such high levels of specialist care. This provision would never be suitable for our daughter.
If respite finishes at 3 Mill Close, our daughter would need a like for like bed based service in a disabled adapted environment with highly trained specialist staff.
Statement for the Health Overview and Scrutiny Committee from the parent of two people who use respite services at 3 Mill Close
I would like to feel that I write this letter on behalf of all the Parents and Carers who use the facilities at 3 Mill Close and other respite centres in Norfolk and will use my own experiences of the ‘system’ to outline to the Scrutiny Committee how things really are. I have addressed this committee before on this subject and feel no shame in reiterating several points to show what a struggle life as a carer can be when the services you truly depend on are under threat.
I am the parent of two very severely disabled grown-up children who currently receive a limited amount of bed based respite care at 3 Mill Close and have done so for many years. The care they receive from the staff is excellent and crucially the environment is safe, secure and loving and we have never had a moments doubt about sending our children there to be looked after. Our children are extremely vulnerable, but we have learnt to totally trust the staff at 3 Mill Close. This trust and understanding for our children’s needs did not happen overnight, but built on over the course of years – such is the way these things must slowly progress when your children are so badly affected by various medical conditions.
All this however is about to change! Why? Because some people in London, who I don’t know, and who certainly do not know me, my children or Mill Close and who probably have to look on a map to see where Norfolk is, have decided that the excellent service we receive which is absolutely vital to keep us going, needs to be shut down!
If I am honest it could be said that we have a difficult life. Both my children have severe Cerebral Palsy and their condition is such that they require 100% total care. This tends to grind you down, especially in our case if on top of all the other problems one of the children has not slept for three days and nights and has screamed continuously and torn clothes and ripped incontinence pads into a million pieces several times over. We really do not need any more worries!
However there can be no ducking the blame for the cause of our worries. Since 2003, Norfolk County Council has put us through an emotional shredder regarding the future of both Respite Care and Dereham Day Services – the threat of them being taken away is constantly on our minds and what on earth we would do without them. We have looked to the Council for help in the past, but have been continually lied to about their future – this is not right and we have been treated disgracefully. We are, as they say, easy targets that should just roll over and accept our fate. Several senior officials in this very building should hang their heads in shame.
The Government and its willing servants will shudder to hear that 3 Mill Close is a perfect example of how a bed based respite care unit should function and past Respite Steering committees (of which I have sat on) acknowledged that this is fact. However this is not what Norfolk County Council or the NHS wanted to hear as it never fitted into the ‘grand scheme’ or the budget, so those Steering Committees were closed down and the findings and recommendations totally ignored.
2.
We as parents of disabled children never get good news – it’s always bad. We do not want to have to continually fight to hang on to the very few things that are essential to keep us going, but that is exactly what we have to do. Everyone we speak to, that is outside Norfolk County Council, think the closure of 3 Mill Close is lunacy, stupid beyond belief as it is exactly what is needed, but what do we know as mere experts for caring for severely disabled children – apparently nothing.
Yes of course, after all the boxes have been ticked, tenders will be placed into the private sector to take on the bed based respite care of our children and the contract will granted to a company that exists purely to make a profit. Would I be too far off the mark if I was to predict that this ‘business’ would be staffed by imported foreign workers on the minimum wage with dodgy nursing credentials and that they will be expected to offer the same level of trust and care currently received by our children at Mill Close?
That I assure you will not be allowed to happen as we will keep our children at home and another one of our vital lifelines will be lost forever.
Norfolk Health Overview and Scrutiny Committee 4 March 2010 Item no 8
Children’s Diabetes and Foot and Eye Screening Services
Report on progress in implementing the recommendations of the Scrutiny Working Group
This report provides an update on progress in implementing the recommendations of the Committee’s Working Group on diabetes, as requested at the Committee’s meeting on 15 October 2009.
1. Background
1.1 Norfolk Health Overview and Scrutiny Committee (NHOSC) established the Diabetes Working Group in November 2008. The membership of the Group included six members of the Committee and one member of Norfolk Local Involvement Network. The Working Group’s terms of reference required it to scrutinise various aspects of children’s diabetes services, and foot and eye screening services for people with diabetes. The Group was asked to speak to service users and carers, Children’s Services, NHS frontline staff and the service commissioners and report back to the Committee with appropriate evidence on whether children’s diabetic, foot and eye screening services in Norfolk were prepared to respond to the predicted increase in demand for those services in the future. It was also asked to make recommendations for service improvement.
1.2 The Committee received the Working Group’s final report on 15 October 2009. The report contained 23 recommendations, applying to different organisations:- NHS Norfolk NHS Great Yarmouth and Waveney Norfolk County Council Children’s Services Norfolk and Norwich University Hospitals NHS Foundation Trust The Queen Elizabeth Hospital NHS Trust James Paget University Hospital NHS Foundation Trust
1.3 Recommendation 18 asked the Great Yarmouth and Waveney Joint Health Scrutiny Committee to maintain an overview of the foot screening service for people with diabetes in the NHS Great Yarmouth and Waveney area until it was satisfied that problems identified by the Working Group had been resolved.
1.4 The Committee accepted all of the Working Group’s recommendations and agreed that each of the organisations should be asked to report back to its meeting in March 2010 as to whether the relevant recommendations were accepted in full, accepted in part or rejected.
1.5 In order to facilitate the capture of this information and minimise the work involved, it was requested that a standard template be used for this reporting. Where recommendations have not been accepted, or only partly accepted, the reasons should be outlined in the comments column. Similarly, for accepted recommendations, it was requested that details be given of any action already taken or planned. Copies of any relevant action plans were also requested.
1.6 The Committee also agreed to add the following addendum to the Working Group’s report, which it asked to be communicated to the organisations involved:
‘The Committee recognises that some of these recommendations will present financial challenges and that in the case of the recommendations regarding services in schools, the finance is under the control of school governors rather than Children’s Services department. Nevertheless, the Committee acknowledges the real need that prompted all of these recommendations and urges the organisations involved to seriously consider ways in which they can be addressed’.
2. Suggested approach
2.1 A template containing all of the responses from the relevant organisations is attached. It is suggested that the Committee looks at each recommendation in turn and decides whether it is satisfied that: Where recommendations have been accepted, there is sufficient evidence that the proposed action has been taken or that clear plans are in place for it to be taken. The grounds given for rejecting or only partially accepting any of the recommendations are reasonable, especially in light of the caveat outlined in paragraph 1.6 above.
2.2 It is requested that, should the Committee decide that it has not completed its scrutiny of this issue, it specifies the remaining issues and how it would like to proceed.
2.3 It is usual practice for the Committee to monitor the implementation of recommendations that have been accepted. In this case Norfolk Local Involvement Network (LINk) has offered to monitor the implementation. The Committee may wish to accept Norfolk LINk’s offer and ask it to alert the Committee should there be any cause for concern.
2.4 The Committee should also note that a copy of the ‘Children’s Diabetes and Foot and Eye Screening Services’ report was forwarded to the Care Quality Commission (CQC) in January following the Committee’s decision to share information with the regulator. The CQC has thanked the Committee for the information and has undertaken to follow up the issues and action points raised with the respective NHS Trusts.
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Norfolk Health Overview and Scrutiny Committee
Report on Diabetes – children’s services and foot and eye screening services – agreed on 15 October 2009
Responses to recommendations
Key: NHS N = NHS Norfolk; NHS GY&W = NHS Great Yarmouth and Waveney; NNUH = Norfolk and Norwich University Hospitals NHS Foundation Trust; QEH = The Queen Elizabeth Hospital NHS Trust, King’s Lynn; JPUH = James Paget University Hospital NHS Foundation Trust; CS = Norfolk County Council Children’s Services Department; GY&W JHSC = Great Yarmouth and Waveney Joint Health Scrutiny Committee
Response Accepted = A Partially accepted = PA Not Accepted = NA
Recommendations
Response A,PA from or NA Comments
Children’s Diabetes Services 1. By March 2010, the paediatric NNUH A Action taken: diabetes team at the Norfolk and a) Started a 4-7p.m. clinic on Thursdays once a week since September 2009. Norwich University Hospital should This clinic is shared equally between the two consultants. It provides more publish details of what action has choice to families who find coming to the Wednesday morning clinics difficult been taken in response to its due to work or school commitments. This has so far proved to be popular. ‘satisfaction with care’ survey and its b) Only one consultant list is being processed per clinic (Wednesday a.m. or outcomes. Thursday 4-7p.m.) i.e. before, there were two consultants doing clinics at the same time (Wednesday mornings) resulting in a bottleneck at the clinic and resulting in long waits for some families. Since the introduction of the Thursday clinic, there is only one list per clinic without any loss of capacity. c) We have started displaying our educational leaflets in the waiting area so that families can pick up whatever is required. d) A Clinical Psychologist has been appointed but is currently on maternity leave. She is due to start in May 2010. It is expected that this person will work for 2 days a week with the children’s diabetes team. e) The 24 hour support to families is still not provided by the diabetes care team as per the NICE guideline. Within the existing staff timings this will not be possible. Out of hour urgent support is still through CAU (children’s assessment unit) .There has not been any delay in response from the team to messages left on the answerphone.
2. The paediatric diabetes teams at QEH A A patient satisfaction survey is currently being drafted and should be distributed to the Queen Elizabeth and James patients/parents in March 2010. Paget University hospitals should conduct ‘satisfaction with care’ JPUH A This is planned for March 2010. surveys, similar to that conducted at the Norfolk and Norwich University Hospital, by July 2010. The results of these surveys should be published, together with the details of any proposals to address issues raised.
3. The Queen Elizabeth Hospital, QEH A A patient satisfaction survey has been discussed with the adult team and is being James Paget University Hospital and jointly drafted to be distributed to the young person’s in March 2010. Norfolk and Norwich University Hospital should instigate a consistent JPUH A This is planned for March 2010. survey of the views of young people aged fifteen and above attending paediatric diabetes or transition NNUH A A survey has been conducted at NNUH and the results are being compiled. They clinics at all three acute hospitals at should soon be available to all. regular 2 yearly intervals, with the first being undertaken by July 2010. Young people should be canvassed as to the services they receive and how these services are delivered.
4. Future reports to the Norfolk NHS A NHS Norfolk has taken note of the findings. The emphasis on supporting greater Health Overview and Scrutiny Norfolk independence for children and their parents/carers in the management of their long Committee should address what the term condition is in accord with our overall strategic direction of travel. relevant agencies have done across More specifically these findings are being fed into two current priority workstreams: Norfolk to act on the conclusions of 1. Joint work with NCC that NHS Norfolk is leading, under the Children’s Trust the report on ‘An investigation into the Learning Disabilities and Disabilities Programme Board, addressing how daily stressors encountered by carers Community Health Service providers can best equip staff in schools to meet of children with diabetes in West their Disability Discrimination Act obligations to support full access to the Norfolk’ from the KiWi Support Group. curriculum. 2. The development of a sustainable Children’s Community Nursing Team (CCNT) that will address the current specialist workforce issues and provide more capacity to support diabetes education to families and schools. QEH A This survey was performed during a time with limited dietetic input and our whole time Paediatric Diabetes Specialist Nurse (PDSN) being on maternity leave with only 0.4 WTE (whole time equivalent) cover during this time. Since the report has been published in March 2009 there have been several changes: Our PDSN has returned from maternity leave in June 2009 part time as 0.6 WTE; initially we had secondment from the ward for the remaining 0.4 WTE until the end of December 2009, but this post has now been permanently filled since February 2010. We have a Paediatric Dietician 0.5 WTE for the diabetes service plus one session every other week at North Cambs Hospital. Regular monthly Carbohydrate counting group education sessions have been started since November 2009 and we are planning to roll out bi-monthly evening sessions for education but also social networking for patients and parents including topics such as sport & exercise, teenager issues etc. However, it is important to point out that some education sessions offered to families had to be cancelled due to poor response. Regarding school plans, since having a full quota of PDSN time there have been no school issues, all care plans have been updated as the need arose and other issues including training resolved. Again with having the full quota of PDSN time, newly diagnosed children are being discharged with full home/school support into the community. The suggestion to update the school care plan in clinic would not be practical due to the time limitation and the need of involvement from school. However, amendments to the insulin regimen will be documented in the Diabetes personal record (if brought to the clinic by the family). CS A Kim Barber, Disability Co-ordinator and Specialist Lead Teacher Physical Disabilities, provides additional support to schools. The points raised in paragraph 1.2.5 of the working group’s report relate to support provided by Health Services. 5. NHS Norfolk and NHS Great NHS PA Within NHS Norfolk the total number of posts for PDSNs is 4.5 WTE. This reflects Yarmouth and Waveney should Norfolk the increased investment made by the NNUH during the course of the Rapid Action ensure that the ratio of paediatric Team negotiations. However, local provider Trusts have struggled to fill this current diabetes specialist nurses to patients establishment due to the national shortage of suitably qualified nursing staff. at all three out-patients clinics is the This workforce issue is therefore being addressed by NHS Norfolk within the wider maximum recommended by the project to develop a Children’s Community Nursing Team (CCNT). This will increase Royal College of Nursing i.e. one full- capacity via a skill mix model and support the professional development of local time specialist nurse for every paediatric nursing staff towards the PDSN role leading to sustained improvement of seventy patients. It is also imperative provision for children with diabetes in the longer term. that continuity of service is The current level of provision is within an acceptable range. The Royal College of maintained. Nursing recommendation is for 1 PDSN per 70 to100 patients. The current ratio across NHS Norfolk is just below one PDSN per 100 patients (total establishment of PDSNs is 4.5 and the number of patients is approximately 440). This is already better than the average ratio of PDSNs across the East of England which is 1:141 patients. The development of the CCNT will further support a sustainable service (i.e. cover for maternity leave) and an improved ratio. NHS A Approval has been given and funding allocated for an additional full-time nurse GY& specialist, to meet the recommendation of 1:70 (see Appendix B). Waveney
6. The acute hospitals should jointly NNUH ? At NNUH we have 3.5 WTE PDSNs in post for about 250 children under the age of ensure that arrangements for training 16 and about 350 children under the age of 18 that our clinic serves. We also have 1 and accrediting paediatric diabetes day of admin support and 1 day of Health Care Assistant time for the children’s specialist nurses are agreed and diabetes team. Currently we have 1 PDSN on long term sickness. implemented on a Norfolk-wide basis. QEH ? It is understood that there have been discussions with Catherine Knox (line manager However it is delivered, this training of PDSN at QEH) and the UEA re local courses and a person specification for the needs to be based on agreed Paediatric Diabetes Specialist Nurse role has been developed. competencies and be assessed and JPUH A The Trust will ensure that training is consistent with national Knowledge and Skills accredited externally. Framework guidelines. The existing relationships between the provider organisations and network involvement will provide the mechanism for addressing issues of consistency and assessment. 7. The Norfolk and Norwich and NNUH NA It is understood that a business case for extra dietetic support was submitted but not Queen Elizabeth Hospitals should agreed by NNUH trust. We need at least 1WTE (which would bring us up to JPUH’s urgently review their provision of staffing). At present NNUH children’s diabetes team is under staffed for the dietetic dietician support for their paediatric time and support. diabetes teams in the light of QEH NA Speaking to the dieticians there has not been a recommendation from the British guidelines from the British Dietetic Diabetic Association regarding a specific ratio for dietician/children with diabetes. Association and the decision by NHS Great Yarmouth and Waveney to provide a full-time post in the NHS PA The internal business case process within the NNUH Trust has not resulted in paediatric diabetes team at the Norfolk increased dietetic resource. NHS Norfolk will continue to work with the NNUH to James Paget University Hospital. A agree a way forward to uplift the provision. Under Payment by Results, the national full-time post should be agreed for the funding scheme for acute hospitals, hospitals are funded by a set tariff for in-patient Norfolk and Norwich University stays and out patient consultations. It is often unclear what should be covered by Hospital, which should be closely this tariff and we will need to resolve this with regard to dietetic support for diabetes monitored and regularly reviewed by clinics and in-patients. Depending upon the outcome of these, further negotiations NHS Norfolk to ensure that this is will take place to secure additional funding. sufficient to provide an effective service.
8. NHS Norfolk and NHS Great NHS A This has been commissioned from both hospital Trusts. QEH have the psychologist Yarmouth and Waveney must have Norfolk in place. NNUH have appointed but the member of staff is currently on maternity arrangements in place for providing leave and it has not been possible to backfill the post. She is due to return to work in dedicated psychological support to May. paediatric diabetes patients to ensure NHS A Approval has been given and funding allocated for 0.4 WTE (whole time equivalent) that there is sufficient capacity for an GY& psychology support, for children who are experiencing difficulties either with their effective service. Waveney diagnosis or aspects of the care required. The service will be provided by the Child and Adolescent Mental Health Service (CAMHS).
9. Norfolk Health Overview and CS A Lesley Whitney, Area Director – Central, and Laura Sutton, Area Service Manager – Scrutiny Committee should be Central, met with clinicians at NNUH on 29 September 2009. Agreement reached provided with a progress report at its regarding meeting in March 2010 on proposals use of Common Assessment Framework (CAF) from Children’s Services to address Professional Consultation with manager in Family Solutions Team (FST) concerns from clinicians at the Norfolk and Norwich University Positive reports re the group work undertaken by Central Family Solutions Team Hospital. (FST) with diabetic children.
10. NHS Norfolk and NHS Great NHS A Please see answer to question 5 above. Yarmouth and Waveney should Norfolk ensure that funding for paediatric diabetes specialist nurses and school NHS PA The approval of funding for the additional specialist nurse will partially address this. nurses is sufficient to provide GY& The role of school nurses is under review. (See Appendix B) effective education and support to Waveney school staff, as well as parents and carers.
11. NHS Norfolk, NHS Great NHS A NHSN considers that this needs to be embedded in a sustainable way and is Yarmouth and Waveney and Norfolk therefore addressing this within the overall work stream under the Children’s Trust Children’s Services should jointly Learning Disabilities and Disabilities Programme Board (See answer to question 4 devise an awareness raising above). The evidence that NHOSC compiled following its research amongst families ‘campaign’ for school staff and agree of children with diabetes demonstrated the variability of response from schools. It is the best way to fund and deliver this. our view that a joint strategic approach from Norfolk County Council, NHS Norfolk This should include consideration of and NHS GY& Waveney will be the most effective and consistent way to maximise the idea of a ‘road show’ with engagement across schools. Training and supporting information will be channelled presentations and supporting through Special Educational Needs Co-ordinators (SENCOs), utilising their information that could be delivered by dedicated website school nurses and members of http://schools.norfolk.gov.uk/index.cfm?s=1&m=67&p=893,index and establishing electronic children’s diabetes support groups links to NHS Norfolk website, Diabetes UK’s website and other appropriate links (eg within schools. the NNUH’s pod casts for young people http://www.nnuh.nhs.uk/Dept.asp?ID=636). This work is being supported by NHS Norfolk’s Communications Team. NHS NA As school responses are geared to specific children and specific needs, our local GY& approach will be to agree with community and school nurses how they interact with Waveney school staff for individual patients. A joint Norfolk approach may be possible later, when different approaches can be put together within a single policy. Children’s Services are being consulted on this also. CS A Children’s Services support the view put forward by NHS Norfolk above.
12. Children’s Services should have CS NA Common Assessment Framework (CAF) meetings can be convened by health a designated senior manager who professionals. can be contacted by a paediatric All diabetic children should have a written health plan. Kim Barber, Disability Co- diabetes specialist nurse, school ordinator and Specialist Lead Teacher Physical Disabilities, provides advice to nurse or parent/carer where a child is schools re the health needs of children. not receiving appropriate support in All area social care teams provide a Professional Consultation service. Day to day school. This person should concerns should be addressed via this process. investigate and, where necessary, meet with the head teacher and chairman of the school governors to identify ways of resolving the situation.
13. Where appropriate support CS A Requests for additional support within school are presented to Single Area Panel cannot be provided otherwise, (SAP) for pupil specific funding. Children’s Services should provide funding for a dedicated helper e.g. a lunchtime supervisor.
14. NHS Norfolk and NHS Great NHS A The issue of equity of access to insulin pumps is a priority issue for the Norfolk Yarmouth and Waveney should take Norfolk Paediatric Diabetes Network. NHS Norfolk is supporting the provision of pump the lead in ensuring that there is an therapy in accord with NICE Guidance. The provision of pump therapy has been integrated strategy for managing the rolled out regionally on a hub and spoke model. Currently, NNUH is one of the best growth in the use of insulin pump developed ‘hubs’ in the region and has considerable expertise in this field. Children therapy across Norfolk, including from across Norfolk are therefore currently able to access pump therapy via the workforce development issues. NNUH diabetes services. QEH has expressed an interest in developing its own pump service. Discussions are ongoing between NHS Norfolk and the QEH to support them in developing their internal business case to set up this service. NHS NA An integrated strategy may be difficult to achieve for two separate PCTs with GY& separate workforce issues. The PCT needs to ensure equitable services for the Waveney whole of its geographic area including Waveney. (See also Appendix B, page 2)
15. NHS Norfolk, NHS Great NHS A NHS Norfolk’s Maternity and Children’s Programme Board has accepted the Yarmouth and Waveney and Norfolk Norfolk recommendations from the Rapid Action Team and is resourcing a Norfolk Children’s Services should take the Paediatric Network. The initial meeting has been convened, with representation from lead in setting up a Norfolk-wide across Trusts. Terms of Reference have been agreed and are attached at Appendix paediatric diabetes network to A. continue the work initiated by the NHS NA NHS GY&Waveney has had a Paediatric sub-group of its local Diabetes network for Rapid Action Team and ensure that GY& some time and needs to ensure equitable services for the whole of its geographic any recommendations arising from Waveney area, including Waveney. However, there is no reason why there should not be that work and our scrutiny inquiry are representation at a Norfolk-wide group and any recommendations arising from that acted on. work and the scrutiny inquiry acted on.
CS PA The NHS Norfolk Maternity and Children’s Programme Board has set up an initial meeting to follow up on the recommendations. A representative of Children’s Services will attend.
16. Norfolk Health Overview and All A Each organisation has responded using this template, as requested. NHS Great Scrutiny Committee should receive Yarmouth and Waveney has also supplied a separate report, which is attached at reports at its meeting in March 2010 Appendix B. detailing responses by the relevant Progress in taking forward the work of the Rapid Action Team is reported under organisations to the working group’s question 15 above. recommendations and progress in taking forward the work of the Rapid Action Team.
Foot Screening Services
17. NHS Norfolk should provide the NHS A NHS Norfolk receives regular reports from the podiatrist who is delivering this Norfolk Health Overview and Scrutiny Norfolk training Committee with a progress report on Key points the roll-out of the training for practice 1. 87% surgeries in central Norfolk now have, or will have by May 2010, a nurses and evidence that this is practitioner who has completed the foot screening training program. having a positive impact on the foot 2. By May 2010, 78 nurses/Health Care Assistants (HCAs) will have received screening service in central Norfolk. training in foot screening since the program started. This should include details of future arrangements for ensuring that all With support from NHS Norfolk, this program will continue into 2010 with practice nurses receive this training. opportunities to train more nurses/HCAs , and also the opportunity for people who have already completed the program to attend a refresher course after 12- 18months.
18. The Great Yarmouth and GY&W A This item is on the agenda for the Joint Committee’s meeting on 10 March. A brief Waveney Joint Health Scrutiny Joint report for that meeting from the Professional and Clinical Head of Podiatry, NHS Committee should maintain an Health Great Yarmouth and Waveney Community Services, is attached at Appendix C. overview of the foot screening service Scrutiny for people with diabetes in the NHS Comm. Great Yarmouth and Waveney’s area until it is satisfied that problems identified by this working group have been resolved.
Eye Screening Services
19. NHS Norfolk should provide the NHS A At present there is no date for a future National Screening Programme External Norfolk Health Overview and Scrutiny Norfolk Quality Audit visit. The last visit was in March 2009 and no indication was given as Committee with details of the next to a return visit, which is a positive position for the screening programme. report by the National Screening There are now two eye screening boards to monitor the two screening programmes Programme on eye screening which support NHS Norfolk. Membership includes commissioning, clinicians, public services in its area, together with the health and staff of the programmes. proposed response to any recommendations.
20. NHS Great Yarmouth and NHS A NHS GY&W monitors the Quarterly coverage and uptake figures produced by the Waveney should monitor and review GY& JPUH Diabetic Retinal Screening Service. It also monitors the exclusions on a the capacity of the diabetic retinal Waveney monthly and Annual basis. All 19 English National Screening Programme for screening service in its area and Diabetic Retinopathy standards are reviewed on a quarterly basis and reported to ensure it has sufficient capacity to the PCT’s Diabetic Screening Programme board. deal with both current cases and new referrals.
21. The eye screening service in the NHS A NHS GY& Waveney is participating in the Audit which is being conducted by the Great Yarmouth and Waveney area GY& National Screening Programme in June 2010 should be subject to regular audits by Waveney the National Screening Programme, in the same way as that in NHS Norfolk’s area.
22. NHS Great Yarmouth and NHS PA NHS GY& Waveney is currently looking into the practicability of conducting an audit Waveney, local GPs and the GY& into DNA’s (‘Do Not Attends’) Screening Service should jointly Waveney This will rely on the co-operation of NHS Suffolk and the JPUH. agree a way forward for reducing the (lead) number of patients not attending appointments.
Patient Care Pathways
23. NHS Norfolk and NHS Great NHS A Although GP practices record their population with diabetes through QOF (Quality Yarmouth and Waveney should Norfolk Outcomes Framework), to ensure all appropriate patients are identified and invited ensure that databases maintained by to be screened additional processes are embedded within the screening GP practices and/or providers of all programme. Six weeks before a due visit by the screening team, the programme screening services, as appropriate, requests from the GP practice a full copy of their diabetic register. All information is are sufficiently robust to identify all then validated against the current list held within the screening programmes and patients with diabetes and ensure supplemented with any other known internal intelligence. that they are invited for appropriate NHS A GP practices use a variety of different systems. GPs or practice managers input screening tests. GY& information on the practice’s ‘population with Diabetes’ which is then submitted to Waveney the QOF (Quality Outcomes Framework) database. A database accuracy check is taking place and GP registers are being checked.
The JPUH Diabetic Retinal Screening Service uses the Orion Software package, one of two English national screening programme recommended systems.
Appendix A
DRAFT Norfolk Diabetes Network Terms of Reference
Background and Role:
Context:
- Publication of Making Every Young Person with Diabetes matter - Norfolk HOSC scrutiny of paediatric diabetes services - Recommendation of Diabetes RAT agreed by NHSN Children and maternity Programme Board
Chair: tba
Membership: Commissioning - NHS Norfolk Commissioning manager for children, Helen Jackson NHS Norfolk Project manager, Sally Child NHS Gt Y&W Children’s Commissioner, Elaine Mash NHS Norfolk Contracting and Performance Manager, Peter Spears
Relevant clinicians from the following Trusts: NNUH, Nandu Thalange, Vipan Datta, Swe Myint, Gill Ward QEH, Barbara Piel NCH&C, Catherine Knox, Sarah Haws JPH, Viji Raman
NCC Children’s Services, Jackie Cole
Diabetes UK local groups for children and young people - KiWi Joanne Dowson - Norwich and District Youth Group, Gail Howes, Rob Scott
Linkage to be made to Dietetics and Psychology as appropriate.
(Minutes for information to PbC Link Carly Hughes)
Responsibilities:
In the context of the raising levels of incidence of diabetes in children, to co-ordinate local pathway development and monitor the impact on outcomes for children and young people (<18) with diabetes, with particular reference to:
Chief Executive: Julie Garbutt Chair: Sheila Childerhouse ______
NHS Norfolk represents the Norfolk Primary Care Trust Appendix A
- level of specialist nurses (and associated workforce issues) - equitable provision of insulin pumps (catch up and ongoing). - the location and delivery of paediatric diabetes services and possibilities to shift clinics from acute to community settings - support processes around transition - the support that is provided by early years settings and schools for children with diabetes and how to improve this - the interface with LA Children’s Services where there are concerns regarding the parents/carers management of the child’s condition.
To ensure the views of service users inform service delivery and development.
To consider how the local paediatric network and how fits with the Regional and local all age networks.
Frequency of Meetings:
Quarterly
Reporting:
Norfolk Diabetes Networks – NIDDM and West Norfolk Network Norfolk Paediatric Network NHS Norfolk Women and Children’s Programme Board
Chief Executive: Julie Garbutt Chair: Sheila Childerhouse ______
NHS Norfolk represents the Norfolk Primary Care Trust Appendix B
A Report to the Norfolk Health Overview and Scrutiny Committee on Diabetes:
1. Introduction
The local clinical Diabetes network was established in 2008 and has provided an excellent focus for commissioners and providers, patient representatives and voluntary organisations, to examine existing pathways of care and agree improvements in service. The network includes a paediatric sub-group.
This has, fortuitously, coincided with the interest of the Norfolk HOSC and lent emphasis to the importance of this work.
It should be noted that 56% of the GY&W population live in Suffolk (Waveney) and one of the PCT’s strategic priorities is to achieve equitable services for all of its population. This includes working with other PCTs e.g. NHS Suffolk and with other Council bodies e.g. Suffolk County Council. This may lead to complications when seeking to achieve integration with, for example, NHS Norfolk.
2. Service areas
i) Children’s services
A business case from the James Paget University Hospital (JPUH) has been approved for recurrent funding from March 2010, to uplift services for children with Type 1 Diabetes (usually about 120 new patients p.a.). This will provide an additional full-time nurse specialist, a part-time (0.4 wte) psychologist and a full-time dietician.
Overall, these post-holders will be able to provide greater patient and family support, education and advice; contribute to better long-term physical and mental health; and help to avoid unnecessary hospital admissions or medical complications. A sequence of performance metrics is being agreed with JPUH for the 2010/11 contract, to enable the commissioners to be assured of an improved standard of service.
Opportunities to support schools that have individual children with Diabetes are being reviewed as per the HOSC recommendations. Our local approach will be to agree with community and school nurses how they interact with school staff for individual patients. Norfolk Children’s Services are being consulted on this also.
NHOSC Diabetes report 1 L. Caine 02.02.10 V2 It is recognised that insulin pump delivery for children is highly desirable (for identified individuals) and a small number of children in GY&W do receive this service. However, the pump and initiation costs are high, so it is an area that can only be addressed gradually.
ii) Foot screening
Recommendation 18. The Great Yarmouth and Waveney Joint Scrutiny Committee should maintain an overview of the foot screening service for people with diabetes in the NHS Great Yarmouth and Waveney’s area until it is satisfied that problems identified by this working group have been resolved.
Despite recruitment difficulties, the community Podiatric team now has a full complement of podiatrists and a re-designed pathway of care that includes primary, community and secondary care (see Appendix C). This is a service primarily for older patients with Type 2 Diabetes.
In detail, as of mid-November 2009 there are 18 podiatrists – WTE 16.95. The podiatry waiting times are greatly improving and the department is 18 week target compliant.
iii) Eye screening
Recommendation 20. NHS Great Yarmouth and Waveney should monitor and review the capacity of the diabetic retinal screening service in its area and ensure it has sufficient capacity to deal with both current cases and new referrals. Recommendation 21. The eye screening service in the Great Yarmouth and Waveney area should be subject to regular audits by the National Screening Programme, in the same way as that in NHS Norfolk’s area. Recommendation 22. NHS Great Yarmouth and Waveney, local GPs and the Screening Service should jointly agree a way forward for reducing the number of patients not attending appointments.
This is a service provided by JPUH to both GY&W patients and those from NHS Suffolk. In 2008/9, 88% of patients eligible received an annual retinal screening test. Investment by the PCT helped JPUH to recruit additional ‘testers’ and move to an electronic database.
In 2009/10, monthly monitoring by the PCT and the East of England Strategic Health Authority has concentrated on achieving 100% take-up by the year end, including people who are housebound or who are ‘hard to reach’.
NHOSC Diabetes report 2 L. Caine 02.02.10 V2 3. Further developments
Further recent developments for people with Diabetes include: community-based DESMOND (Diabetes education and self management for ongoing and newly diagnosed) education and advice for people with Type 2 Diabetes community-based Insulin Conversion for people with Type 2 Diabetes hospital-based DAFNE (Dose adjustment for normal eating) education and advice for people with Type 1 Diabetes improved pathways of care for Chronic Kidney Disease, Lipid management and controlling blood glucose levels (HbA1c) in both primary and secondary care enhanced diet and exercise services for people with Diabetes additional support for smokers who have Diabetes to quit
4. Summary
NHS Great Yarmouth & Waveney is very pleased with improvements in services for people with Diabetes. The role of the Network has been significant and will continue to be so, particularly in relation to monitoring the impact of new services and endorsing further improvements.
NHOSC Diabetes report 3 L. Caine 02.02.10 V2 Appendix C
Great Yarmouth & Waveney Community Services
Recommendation 18 Update – Foot Screening
The following is a brief update on the work taking place by NHS Great Yarmouth and Waveney in relation to diabetes foot screening. Various areas of concern were raised in 2009 and this short paper provides a brief overview of progress in these areas.
Long-standing problems with being able to recruit or retain suitably qualified staff
The podiatry department is now fully staffed with the last vacancy filled in December 2009. As a consequence of this the routine waiting time for patients with diabetes and others has dropped considerably with all urgent cases seen within agreed time frames of 1 working day where a faxed referral is received. Some hot spots still exist where clinical facilities limit availability of time for sessions to take place but we are targeting these whenever possible to reduce any disparity.
Lack of monitoring or an agreed standard for services
The integrated diabetes footcare pathway was signed off by the Great Yarmouth Diabetes Network back in May 2009. Since then the training package developed for practice nurses has been through the approval process and has been ratified by both the Network and the PCT Public Health team. Although agreement has not been reached to make it part of GP practice ‘essential training’, it will be up to the individual practice nurse to ensure that they are competent to carry out this role, so it is in their best interests to attend. Training sessions will begin later this year.
Connected with this, an inability to distinguish between high risk and other patients
This is not yet resolved. However, a template is currently being developed by the PCT that will link into the GP IT systems allowing identification and recording of diabetes risk category at assessment. This will in turn inform the referral through the care pathway.
February 2010
Nick Wright Professional and Clinical Head of Podiatry NHS Great Yarmouth and Waveney Community Services Norfolk Health Overview and Scrutiny Committee 4 March 2010 Item no 9
Changes to local NHS Continuing Healthcare Policy for Adults - Consultation by NHS Norfolk & NHS Great Yarmouth and Waveney
Suggested approach from Maureen Orr, Scrutiny Support Manager
NHS Norfolk and NHS Great Yarmouth and Waveney will present proposals for a new policy on the provision of NHS Continuing Healthcare in nursing homes and in patient’s own homes. The Committee is asked to respond to the consultation.
1. The consultation
1.1 NHS Norfolk and NHS Great Yarmouth and Waveney are consulting Norfolk Health Overview and Scrutiny Committee on options for a new policy on the provision of NHS Continuing Healthcare. A public consultation is also running from 8 February to 3 May 2010.
1.2 The Primary Care Trusts’ report at Appendix A explains the background to the consultation, the financial context and details of how the policy would be applied. The consultation document, which includes details of the proposed new policy, is attached at Appendix B.
2. Purpose of today’s meeting
2.1 Representatives from the PCTs have been invited to today’s meeting to present the proposals and answer the Committee’s questions.
2.2 Norfolk Local Involvement Network (LINk) has been invited to give the Committee its perspective on the proposals. LINk’s comments are attached at Appendix C.
2.3 At the end of the discussions the Committee will be invited to respond to the PCTs’ consultation.
3. Suggested approach
3.1 The Committee may wish to explore the following areas with NHS Norfolk and NHS Great Yarmouth and Waveney:-
a) Is the proposed new policy in line with other PCTs in the region and across the country?
b) How do the PCTs square this proposed policy with the NHS ambitions to increase choice and to provide care closer to home?
3.2 After discussing the proposals with NHS Norfolk and NHS Great Yarmouth and Waveney the Committee may wish to respond to the consultation. The PCTs have set out three options for consideration (the implications of each option are detailed in the consultation document at Appendix B):-
1. Do nothing but continue monitoring and responding to changing levels of risk.
2. The policy changes will apply to new patients only. Existing patients will remain unaffected unless their conditions change or in the case of patients receiving domiciliary care, they become too vulnerable to stay at home.
3. New and existing patients will be affected.
The PCTs’ preferred option is Option 2.
The Committee is invited to state its preferred option and / or to make general comments about the proposed new policy for the PCTs to take into account when considering the overall response to this consultation.
If the Committee chooses a preferred option, it is invited to give reasons for the preference and to say if there is anything about the option that it would change.
3.3 NHS Norfolk and NHS Great Yarmouth and Waveney Boards are both due to consider feedback from the consultation and make their decisions about introducing the new policy on 26 May 2010. The Committee may wish to ask the PCTs to report back on the outcome.
If you need this report in large print, audio, Braille, alternative format or in a different language please contact Maureen Orr on 0344 800 8011 or 0344 800 8011 (Textphone) and we will do our best to help.
NHS Norfolk and NHS Great Yarmouth & Waveney Report for Norfolk Health Overview and Scrutiny Committee for the proposed Joint policy for the provision of NHS Continuing Healthcare to adults: (a) in nursing home placements; and (b) in receipt of domiciliary nursing care packages
The purpose of this report is to provide information for Members of the NHOSC on the proposed new policy around NHS Continuing Healthcare delivered within nursing homes or in the patient’s own home. The intention of the policy is to put in place a clear framework to ensure risks and costs are carefully controlled, while still meeting the health needs of the patient. The paper outlines the current position, reasons for the need for change and the options considered, and should be read with the associated draft policy and consultation document. The policy has been developed jointly for use by NHS Norfolk and NHS Great Yarmouth and Waveney.
1. Background 1.1. NHS Norfolk and NHS Great Yarmouth & Waveney (GY&W) currently have 564 patients (438 in Norfolk, 126 in GY&W) eligible for fully funded NHS Continuing Healthcare (CHC), of which 90 receive nursing care at home (“domiciliary nursing care”). These patients are currently placed across 117 nursing homes and 15 domiciliary nursing care agencies (“providers”), spread across the PCTs’ areas. 1.2. Where, after a full assessment by a multidisciplinary team, an individual meets the CHC eligibility criteria, there is a legal requirement for the PCTs to fund the individual’s reasonable health and social care needs, while at the same time taking into account the finite resources available to them, the competing demands on those resources and the absolute legal obligation to balance their books. 1.3. The individual’s assessed health needs will be met by arranging a care package either in an appropriate registered specialist nursing home or, where feasible and subject to a satisfactory risk assessment, in their own home. 1.4. There is a considerable variation in the charges levied by the nursing homes providing CHC for what is effectively the same level of care. These prices also vary according to needs of the patient and these needs may also dictate which providers are able to cater for them. This can present a dilemma, for example, when a patient/family prefers a more expensive nursing home but another nursing home offers the same care for considerably lower cost; logically, the cheaper home should be chosen as it makes better use of resources. Nurses need a clear policy to help them make the best and most consistent decisions. 1.5. In general, caring for an individual in a specialist nursing home is more cost- effective and safer in terms of managing clinical risk than caring for the individual in their own home for several reasons:
the presence of a greater number of staff (especially in an emergency situation); the availability of cover when care staff go sick; more staff in nursing homes have higher levels of expertise; the purpose-built nature of the care environment; the regime of more regular inspection and quality assurance; the likelihood of emergency backup equipment, such as electrical generators. 1.6. However, nursing homes also have their disadvantages, especially when family members wish to care for their relative themselves and family life is disrupted and restricted by a person needing to be removed from their home environment in order to receive appropriate health care. 1.7. Consequently, a balance has to be struck between personal choice, the risk to the individual/organisation and finite funding available to the PCTs. The proposed policy is intended to deliver a coherent and equitable approach to all the care packages arranged for adult patients eligible for NHS CHC, whether that care is delivered in a nursing home or in the patient’s own home. 1.8. Note that the policy is not intended to be applied either to children or to patients who are approaching the end of their lives and whose needs may change as a result. 1.9. The proposals will only be applied to patients becoming newly eligible for CHC from a date to be decided by the NHS Boards after the comments from the consultation have been taken into account. 1.10. Legal advice has been taken in developing the policy to ensure that it is entirely lawful.
2. Current position 2.1. Of the 90 CHC patients (66 in Norfolk, 24 in GY&W), who receive NHS CHC at home, over 50 care packages cost more than double the average nursing home placement. The average cost across all domiciliary nursing care packages in October 2009 was £7956 per month (the most expensive was a considerable £32,890 per month), as opposed to an average cost of CHC specialist nursing home placements of £4104. 2.2. Estimated costs of alternative care packages that could have been considered/offered show in most cases significant differences in the costs of care at home and care in a registered nursing establishment. It is worth noting that over the past 10 months NHS Norfolk has been able to use less expensive nursing homes and domiciliary nursing care providers and, combined with other efficiencies, this has to a large extent contributed to the predicted full- year cost reduction of £1.5m, although note later comments about the continued rapid growth in the number of people using the service (Para 3.1). 2.3. The risk of a domiciliary care package to both the individual and the PCT has to be acceptable, identified and recorded. The rural nature of the county often makes the risks much higher than in urban areas because of the distances carers have to travel, the isolation of certain homes and the risks posed by, for example, bad weather. This can mean that providing specialist services on a
NHS Continuing Healthcare NHOSC Report on Draft Policy for Nursing Home and Domiciliary Care Provision 2
domiciliary basis in these rural communities can be more challenging as the services are less developed/dependable. This results in an increased risk of breakdowns in service as staff are unable to attend to the patient’s daily needs. 2.4. It is important to note that the majority of patients are at a level of risk that is acceptable. However, as Figure 1 indicates, of the 90 patients receiving care at home, the level of risk to 19 of those patients has been identified as such that there are some concerns for their safety, with serious concerns for a further 4. These issues are currently being addressed and/or robustly monitored through case management.
Figure 1. Levels of risk for NHS CHC Domiciliary Care Patients
3. Financial pressures on CHC budgets and efforts to control them 3.1. Over the past two years, the number of CHC patients has almost doubled both nationally and locally (from 277 in 2007/8 to 601 in NHS Norfolk in 2009/10 and from 98 to 172 in GY&W, although the numbers fluctuate and this represents total activity in the year to date). Just from March 31st to December 31st 2009, there was an increase of 34% in the number of patients eligible for NHS CHC locally. 3.2. This real and rapid growth in the service, has led to roughly a doubling in the cost of the service. Added to this, there has been an increase in unit costs charged by providers. This has been rectified by introducing more robust cost controls and the unit costs are now being brought down to the national average. Work with a commercial partner has allowed NHS Norfolk to benchmark costs, which has helped to set the costs to a lower and more justifiable level, and this exercise continues. 3.3. National benchmarking of the service by the Department of Health shows that there is considerable variation in price across the country. Prices of care packages do vary depending on health needs and complexity. Some providers offer highly specialist services with qualified staff that can meet these specific medical conditions and this is reflected in the cost of the care package.
NHS Continuing Healthcare NHOSC Report on Draft Policy for Nursing Home and Domiciliary Care Provision 3
3.4. NHS Norfolk’s CHC budget had been predicted to be £3.5m overspent by March 2010. As mentioned above, a robust budget-management system is in place and, although significant savings of around £1.5m have been identified to date by changing current policy and practice, further savings could be identified. The proposed policy needs to be considered in the current financial climate. 3.5. Most PCTs have to make financial savings, e.g., NHS Norfolk is looking to ensure costs are effectively managed across all budgets. Savings from this particular initiative are relatively small but an important component of a whole range of savings that PCTs need to deliver, e.g., in the financial year 2010/11, NHS Norfolk will need to deliver savings in the order of £40m to ensure the overall PCT budget remains in balance. Savings targets in this order are likely to continue in the medium term as the NHS is unlikely to enjoy further increases in funding but will continue to experience cost growth in CHC. 3.6. Given the current resource pressures coupled with the increase in predicted and unpredicted demand for CHC services, maintaining the status quo is not a viable option. The PCT cannot sustain the current level of clinical and financial risk. 3.7. The intention of this work is that the price for care at home can be reduced to a level closer to that in nursing homes; the issue is that as the prices in nursing homes are also reduced (as mentioned above) then this differential becomes much harder to eliminate. We are in the process of negotiating a new contract for nursing homes – ensuring quality care is delivered for a standard price – although there will always be higher-cost exceptions. For domiciliary nursing care, we have worked to expand the market and bring in more choice at a lower cost.
4. Proposal and Options Considered 4.1. The proposal covers all new patients who become/are eligible for CHC from the date of implementation. 4.2. If adopted, the new policy should ensure : quality care continues to be provided in a safer environment; individuals will be provided with realistic but possibly more restricted choices; reduced numbers of high-risk cases living in their own homes; care packages are at a realistic and affordable cost; greater consistency and equality of access to CHC services; more robust control of financial expenditure. 4.3. There are three options for consideration for existing patients who are already receiving CHC: 4.4. Option 1 4.4.1. The first option is not to apply the policy to new or existing CHC patients (i.e., ‘do nothing’), except where the identified risk is too great unless and until their healthcare needs significantly increase and they require a more expensive care package.
NHS Continuing Healthcare NHOSC Report on Draft Policy for Nursing Home and Domiciliary Care Provision 4
4.4.2. This ‘status quo’ approach is likely to be unsustainable and will lead to a reduced level of service and choice to the increasing number of patients needing the service over the next few years. 4.5. Option 2 4.5.1. The second option is to apply the policy to new patients only. The policy would not be applied to existing CHC patients, except where the identified risk is too great. 4.5.2. This approach creates inequality of access to healthcare services in that it does not treat existing patients in the same way as new patients, in effect discriminating against new patients. 4.5.3. Using current care packages data, and had this policy been in place in preceding years, the potential cost reduction by setting the threshold at 20% could, by October 2009, have been £79,308 per month or £951,700 for a full year for patients receiving care at home (of which £229,776 per year applies to GY&W patients). However, the costs of existing care packages will remain unchanged, reducing the overall potential for cost reduction. 4.6. Option 3 4.6.1. The third option is to apply the policy both to new and existing patients. The intention would be to delay applying the policy to existing CHC patients, except where the identified risk is too great, for a minimum of 24 months from the implementation date of the policy and then to apply the policy at the second annual review after implementation. 4.6.2. Allowing more time (at least 2 years for all patients) before implementing the policy will afford more time for consultation and better planning/preparation for alternatives, which could be identified within the first year. 4.6.3. This approach caps the financial risk to the PCTs in terms of setting a maximum length of time that it will take to ‘transfer’ all patients onto the new policy. It will also result in reduced risk of inequality of access as all patients will be covered by the same policy in just over 2 years. 4.6.4. The potential cost reduction is higher than for Option 2: potential cost reductions for each year will be the same as for Option 2 (Para 4.5.3) but as the high-costs of existing packages will also be addressed (albeit only after 2 years), the full effect of these savings would be greater.
5. How the Policy will be Applied 5.1. The expectation is that under all these options a few of the existing care packages may need to be changed, possibly meaning that some patients currently receiving domiciliary care will be moved from their own homes into a nursing home and some patients in nursing homes may even need to be transferred to another less expensive nursing home, though this is less likely. 5.2. The proposed process would be:
NHS Continuing Healthcare NHOSC Report on Draft Policy for Nursing Home and Domiciliary Care Provision 5
5.2.1. The CHC Placement and Review Team will identify suitable care packages within a given cost banding. A risk assessment will be undertaken by a clinician who will determine the most appropriate care package(s). Their remit will be to compare costs against the agreed financial threshold. 5.2.2. The term ‘financial threshold’ means the identified additional costs of providing care either in a nursing home or in the patient’s own home as against the lowest-cost equivalent placement that can be provided to meet the patient’s reasonable identified needs and to the quality required by the PCT. 5.2.3. All providers who can provide an appropriate, quality package of care to meet the patient’s reasonable identified needs will be identified. 5.2.4. The lowest-cost care package that can meet the reasonable health needs set out in the care plan and the PCT’s required quality standards will be used as a cost benchmark. 5.2.5. Patients and their families will be offered a choice between all care packages that fall within the threshold, whether provided in a nursing home or at home (where the patient requests such provision and the level of risk is acceptable, as set out in the policy). 5.2.6. Any packages where the costs are above the threshold will not be considered. 5.2.7. If a patient requests a domiciliary nursing care package but the cost is above the agreed threshold, the patient will be offered a placement in an appropriate registered nursing home to be selected in consultation with the patient and their relatives.
6. Appeals, Exceptions and Clarifications 6.1. The use of the PCTs’ Individual Funding Request Panel (IFRP), or a subset of members of that panel with expertise in CHC, to adjudicate on exception cases in accordance with the PCTs’ IFR policy will ensure that any case where there are exceptional circumstances not covered by the PCTs’ policy will be given a fair opportunity to be considered as an exception to the policy. However, to argue a case for ‘exceptionality’ the patient will need the support of their GP or clinician. 6.2. Importantly, the policy explains the circumstances in which patients or their relatives may pay top-ups for additional health or social care services. A recent legal judgment in this area has clarified that this is acceptable as long as the additional services are over and above those provided by the PCT to meet the patient’s reasonable needs. 6.3. Because of the specialist nature of much of this care, NHS Norfolk would not want to impose a rigid limit on the choice of specialist home in terms of distance from the patient’s family at the expense of the provider’s ability to meet the need, however it would be sensible to choose whichever provider is closest to the patient’s family as long as it meets the patient’s health needs, which is of prime importance. The NHS has a responsibility to get the best
NHS Continuing Healthcare NHOSC Report on Draft Policy for Nursing Home and Domiciliary Care Provision 6
value but if a patient/family feel it is unreasonable, they can appeal or apply to the exceptions panel. 6.4. It is not the intention to use the policy to move patients who are stable/settled in a nursing home and whose needs are being met just because a cheaper placement becomes available. Patients would only be moved if their needs changed sufficiently for their care package to be changed and it became apparent that another provider (perhaps cheaper) could better meet their needs. If the difference for the same level of care is greater than the 20% threshold suggested in this draft policy then in the first instance the PCT would question the cost and renegotiate the price with the current provider. If the provider does not reduce costs we would need to consider the next steps but each case would be considered on an individual basis; the draft policy outlines the steps that are available should this situation occur. 6.5. Note that in the policy, long-term is defined as 2 weeks, which seems short at first glance. However, to clarify, the 2 weeks only counts if it indicates the start of a permanent change; if, for example, it was 2 weeks in hospital for an infection, it wouldn’t be counted as a long-term change. All these will be considered on a case-by-case basis. 6.6. Supported living: Note also that several domiciliary nursing packages are cheaper than an equivalent nursing home placement (under the proposed policy, these would not be changed if needs do not change). This indicates that it would be quite reasonable under this policy to move patients from a nursing home to another setting, either at home or a supported living environment. It is proposed that this avenue is explored for 2010/11.
7. Conclusion 7.1. The PCTs cannot continue to take the clinical risks posed by many of the complex domiciliary care packages that currently exist. These increased risks are reflected in increased care package costs, which cannot be maintained by an already overspent budget – largely as a result of the increasing number of patients. 7.2. Clinical placement and reviewing nurses have expressed concern around many of the existing domiciliary care packages and welcome the prospect of a robust policy that would allow placements to be made with more manageable, reduced clinical risks. 7.3. The increasing and disproportionate costs of the high-cost care packages within a finite resource could have a negative impact on new CHC patients for whom the resources will be considerably diminished, with the result that the choices of quality care available to them are reduced and their equity of access to care is threatened. 7.4. Having a clear policy on domiciliary nursing care and nursing home services will allow the PCTs to be open with patients from the start about their options and give the PCTs scope to utilise their limited resources to maximum benefit for patients as a whole.
NHS Continuing Healthcare NHOSC Report on Draft Policy for Nursing Home and Domiciliary Care Provision 7 NHS Norfolk and NHS Great Yarmouth and Waveney Joint Consultation on NHS Continuing Healthcare for Adults
The consultation runs from 8 February to 3 May 2010 Reader Information Box
Description Joint Consultation on NHS Continuing Healthcare for Adults This document sets out the proposed policy being developed to ensure fairness and equity for all patients eligible to receive NHS Continuing Healthcare Other relevant approved documents
Date of Issue January 2010
Review date and by whom January 2011 – NHS Norfolk and NHS Great Yarmouth and Waveney
Prepared by Bozena Allen, Interim Associate Director, Continuing Healthcare, NHS Norfolk Chris Coath, Joint Development Manager, NHS Continuing Healthcare, NHS Norfolk and Norfolk Adult Social Services Department Caroline Howarth, Engagement Manager, NHS Norfolk
Impact Assessment Impact Assessment carried out in accordance with the guidelines
Consultation
Approved by NHS Norfolk Board NHS Great Yarmouth and Waveney Board
Authorised by Julie Garbutt, Chief Executive, NHS Norfolk Dr Sushil Jathanna, Chief Executive, NHS Great Yarmouth and Waveney
Contact details Freepost RRTX-RHYX-RYZG NHS Norfolk Communications Patient and Public Involvement Lakeside 400 Old Chapel Way Broadland Business Park NORWICH NR7 0WG Tel: 01603 595842 Contents page
Foreword 4
1. What is NHS Continuing Healthcare? 5
2. Background 5
3. Our Aim 6
4. The Proposed Policy 6
5. NHS Continuing Healthcare provided at home 7
6. Review of NHS Continuing Healthcare 8
7. The care of patients currently receiving NHS 9 Continuing Healthcare packages
8. Right of Appeal 9
9. Interim measures pending the outcome of 10 an appeal
10. Financial Implications 10
11. Options for Change 11
12. Have your say 12
13. Next Steps 13
14. Consultation circulation list 13
15. Glossary: What the words mean 14
16. About You 15
17. Questionnaire 17 Foreword
This document is issued by NHS Norfolk and NHS Great Yarmouth and Waveney (the PCTs), as the commissioners (buyers) of NHS Continuing Healthcare in Norfolk and Waveney.
The proposals in this document apply to adults - persons aged 18 and over - who have been assessed as having a primary health need and are therefore eligible for NHS Continuing Healthcare, including adults with learning difficulties with complex, intense or unpredictable healthcare (as opposed to social care) needs.
They have been developed following a review of the financial resources available and the clinical risks connected to all aspects of NHS Continuing Healthcare. The over-riding principle is to focus on the quality of the care delivered, and the need for consistency and equality of access to services for all NHS Continuing Healthcare patients within the available financial resources.
We want to give members of the public, people who use services and stakeholders, the opportunity to find out more about what NHS Continuing Healthcare is, and how our proposals can make a difference to those receiving care.
The consultation runs from 8 February 2010 to 3 May 2010.
If you have any questions about this document, please contact:
Caroline Howarth Communications and Engagement Directorate NHS Norfolk Lakeside 400 Old Chapel Way Broadland Business Park Thorpe St Andrew NORWICH NR7 0WG
Telephone: 01603 595842 or e-mail: [email protected]
Copies of this consultation document are available on the NHS Norfolk and NHS Great Yarmouth and Waveney public websites:
www.norfolk.nhs.uk www.gywpct.nhs.uk
We have included a glossary on page 14 to help you understand the meaning of the health terms used in this document.
Joint Consultation on NHS Continuing Healthcare for Adults 4 1. What is NHS Continuing Healthcare?
NHS Continuing Healthcare is a package of care arranged and funded solely by the NHS to meet physical and/or mental health needs that have arisen because of disability, accident or illness. It can be provided in any setting including, but not limited to, a care home, a hospice or a patient’s own home. Patients who may be in need of NHS Continuing Healthcare will be assessed for eligibility against the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. In the context of this document, NHS Continuing Healthcare refers to adults only - that is persons aged 18 years and over.
As NHS organisations, we have a statutory duty to provide services to meet all reasonable health care needs for patients who meet the criteria and are eligible.
The services offered can include healthcare and personal care services and, in some cases, social care and accommodation in nursing homes. Once a patient’s eligibility has been established, and before they can receive an NHS Continuing Healthcare package, a full assessment of their healthcare needs is undertaken by a number of professionals led by a nurse.
Most patients who are eligible for NHS Continuing Healthcare will receive the care they need in specialised surroundings. The treatments, care and equipment required to meet complex, intense and unpredictable health needs often require highly trained healthcare professionals for safe delivery, management and clinical supervision. However, an increasing number of patients eligible for NHS Continuing Healthcare are now provided with care packages which may be delivered in their own homes.
2. Background
NHS Norfolk and NHS Great Yarmouth and Waveney currently have 564 patients eligible for fully funded NHS Continuing Healthcare and of those patients, 90 are receiving care at home.
Annual spend on NHS Continuing Healthcare packages for adults has risen significantly over recent years, as shown in the following table:
Year Norfolk GY&W Total (£ million) (£ million) (£ million) 2007/08 £11.9m £1.3m £13.2m
2008/09 £18.3m £3.2m £21.5m
2009/10 (forecast) £23.9m £7.2m £31.1m
These figures show that the total spend has more than doubled in the past two years. adults has risen significantly over recent years.
Joint Consultation on NHS Continuing Healthcare for Adults 5 Numbers of patients in receipt of NHS Continuing Healthcare resident in NHS Norfolk’s area continue to increase at around 10 per month. This will add further pressure of nearly £6 million per year on the existing budget. A similar proportional rate of increase would be expected within NHS Great Yarmouth and Waveney’s area. This is at a time when the NHS is not likely to receive further uplifts in real term funding beyond 2010/2011.
The domiciliary nursing care has been commissioned (bought) by us for many years. There has been a steady annual increase in the number and cost of these domiciliary care packages. There is also a considerable variation in the charges made by the nursing homes providing NHS Continuing Healthcare for what is effectively the same level of care. This means that the NHS has a dilemma. For example, when a patient or their family member prefers a more expensive nursing home but another nursing home offers the same quality and level of care for a considerably lower cost, why should the NHS not choose the less expensive home if that would be a better use of NHS resources? Choosing the more cost effective option, without compromising the quality of the care being offered, will mean that our budgets are better spent and this, in turn, will go someway towards meeting the cost of the increases in numbers of patients eligible for NHS Continuing Healthcare.
3. Our Aim
Our priority is to ensure that our patients receive high quality NHS Continuing Healthcare, in the safest and most appropriate way possible, according to clinical need.
4. The Proposed Policy
The number of patients with very complex care needs who are receiving NHS Continuing Healthcare has increased significantly over recent times. This means that we need to increase the level of clinical monitoring of those patients, to ensure that if they are highly vulnerable, they do not become more vulnerable by receiving care in an inappropriate environment.
Our most important priority is to ensure that any patient cared for in their own home is safe.
In addition to this, we must, of course, balance the provision of the appropriate level of care for all patients with complex healthcare needs whilst ensuring that we do not exceed our allocated budgets. This means we must commission (buy) the services which are the best value.
We have therefore produced a policy to guide decision-making on the provision of NHS Continuing Healthcare to patients receiving NHS Continuing Healthcare both in registered nursing homes and their own homes. This proposed policy will apply to adult patients only and will seek to ensure that decisions about the care they will receive:-
Joint Consultation on NHS Continuing Healthcare for Adults 6 o are robust, fair consistent and transparent,
o are based on an objective assessment of the patient’s healthcare needs, safety and best interests,
o involve the individual and their family or advocate, where possible and appropriate,
o take into account the need for the PCTs to allocate their financial resources in the most cost-effective way, and obtain the best possible value,
o offer choice where possible, in line with the above.
5. NHS Continuing Healthcare provided at home
Given the complexity of the healthcare needs of those eligible for NHS Continuing Healthcare, we endeavour to provide safe and appropriate care both at home or in a nursing home. However delivering care in the home is often associated with additional risk to the patient and therefore:-
the patient must have the ability to make an informed decision about the location where care is to be provided and care at home must be the patient’s preferred choice. The patient must also fully understand and accept the potential risks and possible consequences of those risks for receiving care in their own home.
it is reasonable to expect that any patient receiving care in their own home will receive a benefit from care being provided in that location.
the full risk assessment (which will cover all the patient’s assessed needs and take into account the availability of any necessary equipment, the environment, the impact of the location where care is to be provided and the availability of appropriately trained carers to deliver the required care) shows that the clinical risks are, in the opinion of the NHS, within acceptable and manageable limits. If we consider the risks are too high, a domiciliary care package will not be appropriate and the patient will be offered an appropriate placement in a registered nursing home.
a care package can be provided that meets both the patient’s reasonable care needs and standards which are acceptable to us as NHS commissioners (buyers) of services.
care can be delivered safely to the patient and without undue risk to the staff providing that care.
the provider chosen to deliver the care has agreed to accept the assessed level of risk to its staff of managing the care package.
Joint Consultation on NHS Continuing Healthcare for Adults 7 o the patient’s GP has agreed to provide primary medical services to the patient in their own home.
o we have taken into account the views of other members of the patient’s household which have been made known to us in writing.
o the total cost of providing the package of nursing care in the patient’s own home (to meet the patient’s reasonable health needs as highlighted in the care plan) is not more than 20% above the cost of a registered nursing home placement providing an equivalent care package.
6. Review of NHS Continuing Healthcare
Patients who are eligible for NHS Continuing Healthcare will have their eligibility reviewed after the first three months, and then on an annual basis, or more frequently if their healthcare needs change at any time. These reviews will include input from the individual, their family or where appropriate, their advocate.
Where the patient is currently receiving a care package in a nursing home and a review of their needs shows that the level of long-term care they are receiving must be increased, the nursing home provider will be assessed to ensure that they remain capable of providing the level of care needed. Where appropriate, to ensure that the needs of the patient are best met, we may offer to provide a placement in an alternative nursing home, or we may offer a revised package of care in the same nursing home.
Where the patient is currently receiving a care package in their own home and a review of their needs indicates an increased level of care is required, a further assessment will take place to determine whether or not the increased level of care required can continue to be safely delivered at home. In cases where we feel the risks to the patient are too great, an alternative care package in a nursing home or hospice will be offered, to ensure that the patient’s needs are met in the most suitable way.
Patients or their families may contribute a financial ‘top up’ to fund additional care or facilities that are over and above the care package provided by us to meet the person’s reasonable needs. ‘Top up’ arrangements must be made separately from the care package funded by the NHS and it will be the responsibility of the patient or their family to ensure that all providers of the ‘top up’ care are aware that the NHS is not responsible for any top-up payments. These arrangements must be made directly between the patient/family and the service provider, but only after the relevant NHS organisation has been notified so as to allow us to make sure that if additional care is being purchased as part of the proposed arrangement, this care does not replace or conflict with any element of the services we are funding, as set out in the agreed care plan.
In the event that circumstances change and the individual or their family no longer wish to fund ‘top up’ care, we will not subsidise or assume responsibility for funding the additional care.
Joint Consultation on NHS Continuing Healthcare for Adults 8 7. The Care of Patients currently receiving NHS Continuing Healthcare packages
Within NHS Norfolk and NHS Great Yarmouth and Waveney at the present time, there are 23 patients who are deemed to be highly vulnerable and are receiving care in their own homes. The current spend on those 23 cases is £2.3 million per year which is around 9% of the total NHS Continuing Healthcare budget, whereas the patients constitute only just over 4% of those in receipt of NHS Continuing Healthcare. If these patients were being cared for in nursing homes, we would normally expect the annual cost of their care to fall by about £1 million per year. It is anticipated that there will be a maximum of 25 highly vulnerable patients receiving NHS Continuing Healthcare packages of care at any one time.
Should this proposed policy be implemented, all current patients at high risk will be reassessed as a priority to ensure they are receiving appropriate care. Provided the risks to the patient or their carers, including NHS staff, of a care package being delivered in the patient’s own home remain reasonable and manageable and the reassessment does not indicate a need to change the care package, we will continue to provide and fund their existing package until such a time as the risks become unacceptable.
Where a patient’s condition has improved or stabilised to such an extent that they are no longer eligible for NHS Continuing Healthcare, they will be entitled to an assessment of needs against the Fair Access to Care criteria from the Local Authority. This may result in the individual being means tested and possibly charged for all or part of their ongoing care, although they may be eligible for NHS-funded nursing care or a joint care package partly funded by the NHS.
Where a domiciliary nursing care package has ‘broken down’ (i.e. difficulties have arisen which mean that the provider is unable to deliver appropriate care), providing it continues to be appropriate for the care of the patient to be delivered in their home, we will arrange a replacement care package from an alternative provider. At this time, we will give written notice to the patient and their family that if the second care package should break down, the patient will be moved to an appropriate ‘back-up’ registered nursing home, or other appropriate place of safety, which meets their needs. In those circumstances, if the placement offered is not acceptable to the patient or their family, they may arrange and fund their own domiciliary care package or alternative nursing home placement.
Patients or their families who refuse the care packages we have offered will not be prejudiced should they wish to take up an offer of NHS services at a later date.
8. Right of Appeal
If a patient wishes to appeal the outcome of an NHS Continuing Healthcare eligibility review, the appeal process set out in our relevant Operational Policy Frameworks will be used.
Joint Consultation on NHS Continuing Healthcare for Adults 9 Where a patient is not satisfied with the application of any aspect of this policy in relation to their own case, they may appeal the offer of a placement or care package in writing within 28 days of the offer being made.
Appeals may also be made on the grounds of ‘exceptionality’ with the support of the patient’s own GP or another appropriate clinician.
9. Interim measures pending the outcome of an appeal
If a patient or their family decides to appeal against our decision to place the patient in a registered nursing home as opposed to providing a domiciliary package of care, an appropriate interim placement will be offered, taking account of the patient’s safety as the over-riding factor, until the outcome of the appeal has been determined. If the patient or their family refuse the offer of an interim placement pending the outcome of the appeal, they may arrange and fund their own domiciliary care package for this period.
If the outcome is in favour of the patient and their family, we will ensure that a revised package of care, which has been developed in full consultation with the patient and their family/advocate, is provided.
If the outcome is in our favour and the placement offered is still not acceptable, the patient and their family may continue to arrange and fund their own domiciliary care package or alternative placement.
10. Financial Implications
As mentioned in Section 2, the costs of providing NHS Continuing Healthcare are steadily increasing each year. Based on October 2009 figures, the average cost of all domiciliary nursing care packages is £7,956 per month (to a maximum of £32,890 per month), as opposed to an average monthly cost of specialist nursing home placements of £4,104.
People are now living longer and as a result of this, the demand for NHS Continuing Healthcare has risen and continues to rise, resulting in an increase in the costs of providing such packages of care. This is part of the reason for the development of this proposed policy, which seeks to ensure that the anticipated growth in demand is managed within the context of other NHS budgets. The implementation of the policy will ensure that all patients who are eligible for NHS Continuing Healthcare will receive it, although it will mean that the options for domiciliary care/nursing home packages may be more restricted than they are at present. Assessment of the clinical risk for each patient will be the main deciding factor for an offer of an appropriate package of care.
Joint Consultation on NHS Continuing Healthcare for Adults 10 11. Options for Change
There are three options for consideration:-
1. Do nothing, but continue monitoring and responding to changing levels of risk Implications o Existing and new patients will continue to have choice of where they receive their NHS Continuing Healthcare
o The cost of care will increase at a higher rate than other options
o Greater cost savings will need to be made from other services
o Potential inability to provide complex services to an increasing number of the most vulnerable patients living in the community
2. The policy changes will apply to new patients only. Existing patients will remain unaffected unless their conditions change or in the case of patients receiving domiciliary care, they become too vulnerable to stay at home Implications
o Existing patients will continue to receive the same level of care that they do now, unless their health needs change or, in the case of domiciliary care, they become too vulnerable to stay at home
o Any changes to care will be made on a clinical risk assessment basis
o Most vulnerable patients new to NHS Continuing Healthcare may have, in some cases, restricted choice of where their care is provided
o Savings of approximately £1 million per year could be made. Better spending of the budget will go someway towards meeting the cost of the increase in numbers of patients eligible for NHS Continuing Healthcare
o Safer care for patients will be provided
3. New and existing patients will be affected Implications o Patients currently in receipt of NHS Continuing Healthcare will be reviewed
o Once reviewed, if the cost of care exceeds the 20% threshold, a transition period of up to a maximum of two years will follow. During this time, arrangements will be made for patients to receive alternative appropriate care
Joint Consultation on NHS Continuing Healthcare for Adults 11 o Any changes to care will be made on a clinical risk assessment basis
o Most vulnerable patients new to NHS Continuing Healthcare may, in some cases, have restricted choice of where their care is provided
o Savings in excess of £1 million per year could be made. Better spending of the budget will go someway towards meeting the cost of the increase of numbers of patients eligible for NHS Continuing Healthcare
o Safer care for patients will be provided
Our preferred option is Option 2.
12. Have your say
We are working with local support groups to ensure that we obtain the views of as many people who may be affected by these proposals as possible.
We want to know what you think, so please answer the questions on pages 15 to 18. You can either visit www.norfolk.nhs.uk to complete and submit the form online, or send pages 15 to 18 to us in an envelope to the FREEPOST address (no stamp needed) below:-
Freepost RRTX-RHYX-RYZG NHS Norfolk Communications Patient and Public Involvement Lakeside 400 Old Chapel Way Broadland Business Park NORWICH NR7 0WG
The consultation will run from 8 February to 3 May 2010.
If you would like a copy of the Draft Policy, please contact Caroline Howarth on 01603 595842.
Joint Consultation on NHS Continuing Healthcare for Adults 12 13. Next Steps
All responses to this consultation will be analysed and a summary report of those responses will be written and published. This report will be placed in the public domain and presented to the NHS Norfolk Board at their public meeting on 26 May 2010 and the NHS Great Yarmouth and Waveney Board.
The outcome of the consultation will be used to influence the final policy for the provision of NHS Continuing Healthcare to adults in nursing home placements and in receipt of domiciliary nursing care packages within the NHS Norfolk and NHS Great Yarmouth and Waveney areas.
14. Consultation circulation list
Age Concern Norfolk Coalition of Disabled People Local Support Groups Patient Participation Groups Norfolk LINk Suffolk LINk Norfolk Health Overview and Scrutiny Committee Great Yarmouth and Waveney Joint Health Overview and Scrutiny Committee Suffolk Health Overview and Scrutiny Committee GP Practices Local Medical Committees All Staff Norfolk Adult Social Services Department Suffolk Adult Social Services Department Key non-statutory and voluntary organisations
Joint Consultation on NHS Continuing Healthcare for Adults 13 15. Glossary
What the words mean
Word or phrase Meaning
Advocate A person who speaks on behalf of you.
Clinician A person who is professionally qualified to provide health care services to patients.
Commissioning ‘Buying’ the right services to meet health care needs, then checking that the care package bought was the right care.
Domiciliary Care Care provided in a person’s own home.
Local Authority Norfolk Social Services - for Norfolk and Great Yarmouth patients Suffolk Social Care Services - for Waveney patients.
NHS Continuing A package of long term care arranged and funded solely by the Healthcare NHS to meet the physical and/or mental health needs that have arisen because of disability, accident or illness of a patient assessed as having a primary health need. It can be provided in any setting including, but not limited to, a care home, a hospice or a patient’s own home.
NHS Norfolk, NHS organisations commissioning and providing health services to NHS Great Yarmouth patients. and Waveney
Provider Organisation which provides NHS nursing care on behalf of the PCT.
Stakeholders Organisations and individuals with an interest in the activities of the NHS. Stakeholders are involved in partnership working and are used for consultation purposes.
Joint Consultation on NHS Continuing Healthcare for Adults 14 16. About you
These questions are about you. We are asking these because they help us make sure that our consultation is reaching everyone it needs to. We treat this information as confidential and do not keep it or use it for any other purpose. We would be grateful if you could complete these questions as fully as possible.
1. What is your postcode? (we need the first part only)
2. Are you? Please tick one box only Female Male Transgendered
3. What was your age on your last birthday? Please write in the box
4. Are you responding as? (Please tick as appropriate):
Someone who receives NHS Continuing Healthcare Carer for someone who uses these services (family member or friend) Member of the public Social worker/paid carer GP/other primary care/secondary care worker NHS Staff member
A member of an organisation or group (please give the name) Other - please state:
5. Which of the following options best describes how you think of yourself? Please tick one box only Heterosexual (straight) Gay or Lesbian Bisexual Other Prefer not to say
Joint Consultation on NHS Continuing Healthcare for Adults 15 6. Which of the following best describes you? Please tick one box only
White Mixed Asian or Asian British
White British White and Black Indian Caribbean Irish Pakistani White and Black African Eastern European Bangladeshi White and Asian Any other white Any other Asian background Any other mixed background background
Black or Black British Chinese Unable to understand
Caribbean Any other ethnic group Prefer not to say
African Other, please state Any other Black
Joint Consultation on NHS Continuing Healthcare for Adults 16 17. Questionnaire
1 Which of the three options listed do you prefer? (please tick)
Option 1 Option 2 Option 3 Don’t know
2 Why do you prefer this option?
3 Is there anything in this option that you would change? (please say what)
Joint Consultation on NHS Continuing Healthcare for Adults 17 4 Do you think our preferred option helps us to meet our aims as shown on page 6? (e.g. ensuring all patients in need of NHS Continuing Healthcare have equal access to services and receive the safest and most appropriate care possible.)
Yes No Don’t know
5 Is there anything else you would like to say about the proposals or options?
Joint Consultation on NHS Continuing Healthcare for Adults 18 If you would like this document in large print, audio, Braille, alternative format or in a different language, please contact NHS Norfolk on 01603 595842 and we will do our best to help.
NHS Norfolk Lakeside 400 Old Chapel Way Broadland Business Park Norwich This document has been produced by Norfolk NR7 0WG NHS Norfolk.
Tel: 01603 257000 Publication date: February 2010 Web: www.norfolk.nhs.uk
Photographs from: The NHS Photo Library NHS Continuing Healthcare:
March 4th HOSC - Norfolk LINk response.
Background.
NHS Continuing Healthcare is a package of care arranged and funded solely by the NHS to meet physical and/or mental health needs that have arisen because of disability, accident or illness.
The proposals in the Consultation document apply to adults (persons aged 18 years and over) who have become eligible for NHS Continuing Healthcare, including adults with learning difficulties.
A Draft Policy has been produced which seeks to ensure that NHS continuing healthcare within the county of Norfolk is provided equitably and fairly for all eligible patients. It has been developed following a review of the financial resources available and the clinical risks connected to all aspects of NHS Continuing Healthcare.
When responding to the Draft Policy, LINk are pleased to endorse the objective of ensuring that NHS continuing healthcare is provided equitably and fairly. Achieving this standard of service provision is the underlying motivation behind LINk’s response.
Norfolk LINk will also respond to the consultation directly to NHS Norfolk and NHS Great Yarmouth and Waveney within the specified timescales of the 12 week consultation period.
Initially, LINk has the following concerns;
As a point of principle LINk believes that a patients’ future should not be assessed purely on a cost basis. LINk is concerned by the introduction of the 20% cost ratio. There needs to be a practical process whereby a degree of discretion could be exercised to ensure that a person-centred approach is followed. It therefore, follows that people should not be moved against their wishes, as patient choice should not be allowed to diminish. The need to save costs should not be allowed to be the key driver.
In this context healthcare should endeavour to maintain independence and should allow people to stay at home for as long as possible.
The needs of the family / partner must be considered as they could have increased travelling distances as a consequence of this proposal.
A potential move to a nursing home raises further questions regarding whether they are in the most suitable location, and also whether they are adequate to provide the support expected with properly trained staff. Nursing homes need to understand potential new patients’ needs, to have the correct equipment and must have the correct numbers of staff at all times.
PCT(s) propose that the new policy should only apply to new patients (Option 2). However, there is a suggestion that patients could still move as their clinical needs and, or exposure to risk changes. Would the family be involved in assessing these risks and would the patient have their own wishes respected? The preferred Option 2 raises the expectation that in time all patients could move to nursing care. However, LINk would be keen to ensure that choice of provision is not diminished as a consequence.
Many nursing homes operate as independent businesses who must maintain profit margins to be able to deliver the service. Cost cutting to maintain profit levels must not be allowed to negatively impact on care levels.
Any future service provision needs to recognise the increasing numbers of patients requiring support and must ensure that service provision is available in the right place to meet patient’s needs.
LINk requests more detailed financial information to be able to understand the costs involved, which will help to gain an appreciation of why costs have continued to increase.
LINk Recommendation;
LINk recommends that once the feedback from the consultation has been assessed, the issue should return to HOSC at a later date.
Norfolk Health Overview and Scrutiny Committee 4 March 2010 Item no 10
Relocation of Costessey Medical Practice
Information Report from NHS Norfolk
Suggested approach from Maureen Orr, Scrutiny Support Manager
NHS Norfolk will present an information report on Costessey Medical Practice’s plans to relocate to new premises on the former site of the Roundwell public house, Dereham Road. The relocation will involve closure of two existing premises; the Practice’s main surgery on Longwater Lane and a part-time branch surgery on Valley Road, Costessey.
1. Background
1.1 Since the Health and Social Care Act 2001 came into force NHS bodies have been required to consult Health Overview and Scrutiny Committees about substantial variations or developments of local services. This includes significant changes to local GP services, where the Primary Care Trust (PCT) would be expected to alert the Health Overview and Scrutiny Committee.
1.2 In August 2008 NHS Norfolk implemented a branch closure policy that requires GP Practices to consult patients, the public and the Health Overview and Scrutiny Committee about proposals to close branch surgeries before the Primary Care Trust approves the plans.
1.4 The outline proposal to build new premises for Costessey Medical Practice was originally approved by South Norfolk Primary Care Trust in December 2005 but the project was delayed by the merger of the five former PCTs into NHS Norfolk in October 2006. NHS Norfolk re-approved the outline business case in January 2008 and the full business case in July 2008. Thus, full approval had already been given to the Practice’s plans before NHS Norfolk’s branch closure policy was introduced in August 2008.
1.5 Following the introduction of the branch closure policy Costessey Medical Practice organised a public and patient consultation on its approved plans from July to September 2009.
2. Why has NHS Norfolk brought the subject to the Committee’s attention now?
2.1 There has been some opposition to closure of the Valley Road surgery because of concerns about access to the new surgery. Opponents also pointed out to NHS Norfolk that the Health Overview and Scrutiny Committee had not been consulted about the proposals.
2.2 In response, NHS Norfolk offered to give the Committee an information report and an opportunity to comment on Costessey Medical Practice’s relocation plans. The report, which includes responses to concerns about closure of the Valley Road branch surgery, is attached at Appendix A. A map showing the locations of the Roundwell site, the two existing Costessey Medical Practice sites (main surgery and branch surgery) and neighbouring medical practices is attached at Appendix B.
2.3 It is important to note that NHS Norfolk has already approved Costessey Medical Practice’s plans to relocate. The report presented today is therefore an information report, not a formal consultation with the Committee.
3. Suggested approach
3.1 The Committee may first wish to decide whether or not it considers relocation of Costessey Medical Practice to be a substantial variation in service. The term ‘substantial variation’ is not defined in law, but it can be any change that the Committee thinks will have a significant effect on patients.
The East of England Health Overview and Scrutiny Committees Chairs Forum has produced a Good Working Practices document that gives some guidance on aspects to consider when weighing up the significance of a proposed change:-
Changes in accessibility of service. Impact on the wider community. The degree to which patients and carers are affected. Changes to methods and models of service delivery. Financial implications for the NHS or other organisations. Impact on other services. Cumulative effect of smaller changes.
A change that has a detrimental effect on a small number of patients could be defined as ‘substantial variation’ if the effect is considered to be severe.
3.2 If the Committee thinks that the relocation of Costessey Medical Practice is not a substantial variation in service then it may decide not to consider the subject any further.
3.3 If the Committee thinks that the relocation is a substantial variation in service then it follows that the Committee would have expected to be formally consulted at an earlier stage, preferably before the outline plans were approved by South Norfolk PCT in 2005.
Had the Committee been formally consulted it would have considered two questions:-
(a) Has the consultation with the Committee been adequate? (b) Are the proposals in the interest of the local health service?
You may now wish to consider (b).
3.4 Nikki Cocks, Director of Independent Contracts and Providers, NHS Norfolk and Jan Hardinge, Managing Partner, Costessey Medical Practice have been invited to the meeting to answer any questions arising from NHS Norfolk’s report (Appendix A) or other issues concerning the relocation.
After questioning, the Committee may wish to decide:-
Are the plans in the interest of the local health service?
3.5 Like every other GP practice, Costessey Medical Practice is an independent business. It is important to realise that the Practice has already received the necessary approval from the PCT to proceed with its relocation plans and work has already started on the Roundwell site.
If the Committee was to conclude that the relocation plans are not in the interest of the local health service then it would need to pursue the matter with NHS Norfolk rather than with Costessey Medical Practice. If necessary, the Committee could ask the PCT to explore ways of mitigating the negative effects of the relocation.
3.6 Finally, the Committee may wish to ask NHS Norfolk if there are any other cases, yet to come to fruition, where branch closure plans were approved before the PCT adopted its 2008 policy stipulating consultation with the Health Overview and Scrutiny Committee.
If you need this report in large print, audio, Braille, alternative format or in a different language please contact the Scrutiny Support Team on 0344 800 8020 or Textphone 0344 800 8011 and we will do our best to help.
Appendix A
REPORT TO: Health and Overview Scrutiny Committee
FROM: Nikki Cocks, Director of Independent Contracts and Providers, NHSN
SUBJECT: COSTESSEY MEDICAL PRACTICE PREMISES UPDATE
DATE: 12th February 2010 ______
1. INTRODUCTION
1.1 Developers have just started work to build new premises for the Costessey Medical Practice, which will result in closure of both the main and branch surgeries.
1.2 There has been recent challenges via the Green Party to the consultation process surrounding the premises changes, and thus a meeting will be held 16th February 2010.
1.3 The PCT has assured itself that a public consultation has been carried out and the concerns that were subsequently raised have been considered, and responded to, by the practice. In order to ensure a completely transparent process we have contacted HOSC to inform them as to the changes underway and concerns raised to date.
2. HISTORY and BACKGROUND
2.1 In December 2005 the partners submitted an outlined business case (OBC) for rebuild of the Costessey Medical Practice which Southern Norfolk PCT granted approval to proceed to a full business case. This was somewhat delayed due to the merger of the 5 PCTs into NHS Norfolk, 01 October 2006.
2.2 NHSN considered all OBC passed by predecessor PCTs in December 2006, and agreed to develop a standard set of criteria against which to prioritise outstanding schemes. This included the Costessey development.
2.3 In March 2007 NHSN Board agreed the criteria – with the maximum score being 19. 17 schemes were considered, the Costessey development scored 17/19 and was ranked joint second. In January 2008 the Costessey Medical Practice OBC was reapproved by the Board, and the minutes state that ‘the Board have viewed the Costessey practice and recognise the current premises are inadequate’.
2.4 The Full Business Case was approved at Board on 22 July 2008 subject to the outstanding value for money report from the District Valuer being satisfactory.
2.5 The Practice operates from two sites, Longwater Lane and Valley Road. The main site is Longwater Lane and is open from 0800 to 1830. The Valley Road branch surgery is open 0830 to 1130 each morning, and provides 80 GP appointments and 105 nurse/healthcare asst appointments per week. Any need for appointments or healthcare outside those times will be addressed via the Longwater Lane surgery.
2.6 The proposal included the Practice shutting both their current premises (main and branch surgery) to relocate into a new build on the former site of the Roundwell Pub. The proposal was submitted in order to provide additional capacity for the practice to accommodate patients resulting from additional housing (circa 3000+) being built in the area. Neither surgery provides adequate space nor are they DDA compliant.
2.7 No formal public consultation was carried out during the outline business case stages.
3. PCT BRANCH CLOSURE POLICY
3.1 The PCT now operates a branch closure policy, which is primarily to consider applications from practice to close a branch while continuing at their current premises. Recent discussions have culminated in agreement that where the PCT is considering relocation of a practice that results in closure of the branch surgery, elements of the branch closure policy need to be followed.
3.2 Thus before submitting a formal application, a practice should consult patients about the proposed changes: The consultation period should last a minimum of 90 days It should commence with a notice in the local press At least one public meeting should be held Consultees would normally include the practice’s Patient Participation Group, the local Involvement Network (LINKs), and the local Overview and Scrutiny Committee.
3.3 The branch closure policy was approved by the Primary Care Programme Board on 17 July 2008, and implemented with effect from 18 August 2008. It was therefore not in existence when the Costessey full business case was approved.
4. PRACTICE PUBLIC CONSULTATION
4.1 On the evening of 1st July 2009, a public meeting was held at Breckland Village Hall attended by 68 people. The meeting having been advertised by way of a large article in the Evening News and also various notices in both surgeries. At this meeting plans for the new surgery were presented and questions invited. This signified the commencement of a formal 90 day patient/public consultation period.
4.2 The patient/public consultation period was announced by the Practice in the public notice sections of the Evening News and Eastern Daily Press on 2nd July 2009 which ran to 28th September 2009.
4.3 The practice received a total of 62 letters of opposition, and 66 signatures on a petition collated by one of the local residents. This accounts for 1.4% of the practice population.
4.4 The Practice Manager wrote individually to everyone who wrote or signed the petition, addressing the concerns raised. Two replied stating that the response had allayed their fears, and thanking the practice manager for addressing them.
4.5 The Practice Manager compiled a brief summary report which detailed number of objections, the concerns and the practice response. In the light of ongoing pressure from the Green Party, the report was passed to the PCT. Sections 5 and 6 below are taken from that report.
4.6 The PCT has arranged to meet the Green Party with the Practice (revised date to be agreed) to try and resolve the differences and conclude the discussions.
BP/NC February 2010
5. OBJECTIONS
5.1 Objection to date, largely centre on perceived access problems and the proposed closure of the Valley Road, branch surgery.
5.2 Formal written objections have been received by the PCT on 28th September 2009, from Green Party City Councillors. Whilst not objecting to the expansion of the Costessey Medical Practice, nor the building of new premises on the former Roundwell Pub site, they are opposed to the closure of the Costessey Medical Practice (Valley Road) branch surgery. Their objections cover the following five points:
5.2.1 Access to new Roundwell site from those in the Valley Road area: Concern expressed at the ability of many current Valley Road surgery patients to attend the new Roundwell site. The distance from the current Valley Road surgery to the new premises is roughly 1.7 miles walking distance. The current bus route is normally every 30 minutes but is thought to be unreliable.
5.2.2 Lack of alternative surgeries for those in the Valley Road and Marlpit area: For those patients who choose not access the Costessey Medical Practice due to access difficulties there are insufficient alternatives available. The nearest alternative GP Surgery to Valley Road being West Earlham, approximately 1.4 miles walking distance. The Bates Green surgery on the Marlpit estate is nurse led and does not offer GP services.
5.2.3 Demographics: There are significant numbers of elderly people living in the Valley Road area who potentially depend on the current branch surgery. The New Costessey area around the Valley Road Surgery (SOA UH918) has a higher than average percentage of pensioners living there – 28% compared to 24% in Norfolk, 20% in East of England and 19% in England.
Concern has also been expressed that patients living in the Wensum / Norwich City Council area were not taken into account when preparing the statistics to support the new Medical Practice plan. The catchment area for Costessey Medical Practice includes Woodhill Rise, Winsford Way, Camborne Close and Leewood Crescent, which lie in the Norwich City Council area (Wensum Ward). Version 1.0 of the plan refers only to Old Costessey and New Costessey wards. Wensum Ward has 56.79% of its population in the 10% most deprived areas in Norfolk compared to 0% in Old Costessey.
5.2.4 Minimal and inadequate publicity of consultation: A notice of the consultation for the proposed closure of Valley Road Branch was placed in the Public Notices section of the Norwich Evening News on Monday 6th July 2009. This notice measured 59mm by 32mm and was written in small font size. The argument being that residents previously unaware of the consultation would not have seen this notice. This is in contrast to the full article in the earlier addition of the Evening News advertising the public meeting to discuss the new Roundwell site, which did not mention the closure of the Valley Road Surgery.
5.2.5 Consideration of alternatives to closing the Valley Road Surgery: Costessey Medical Practice has argued that the Valley Road surgery is “unfit for purpose” on the grounds that it is not DDA compliant and that it is not effectively soundproofed. Green Party City Councillors argue that they have not seen adequate information justifying that reasonable adjustment could not be made to the existing premises.
BP/NC February 2010
6 RESPONSE TO OBJECTIONS
6.1 In response to the above objections from Green Party City Councillors, Jan Hardinge, Managing Partner, Costessey Medical Practice, has put forward the following counter arguments.
6.1.1 Access to new Roundwell site from those in the Valley Road area: Many Practice patients, including elderly patients, live in excess of 1.7 miles from the surgery and still manage to attend. Easton, Bawburgh and Marlingord do not have a branch surgery close by, nor do they have a bus service to Costessey.
6.1.2 Lack of alternative surgeries for those in the Valley Road and Marlpit area: There are alternative GP services for Costessey residents at Beechcroft. West Earlham Health Centre provides GP cover for the Marlpit area and parts of Costessey falling under the Norwich City Council umbrella. Whilst the Bates Green Surgery is nurse led, there is a duty doctor on site. Also a Nurse Practitioner on site can diagnose, treat and refer patients.
6.1.3 Demographics: GP Practices are contractually obliged to provide medical services to patients within their practice area. Patients living in the Wensum Ward and Norwich City Council area have only been able to continue accessing Costessey Medical Practice as a gesture of goodwill on behalf of the Practice. The Practice is not contracted by NHS Norfolk to provide GP services to these areas.
6.1.4 Minimal and inadequate Publicity of consultation: Patients in this area have been well aware of the Practices plans to relocate to a new site. Certainly it has been in the public domain for at least 5 years. Over the years Practice plans have received a huge amount of press coverage and the detailed plans have been available to the public in both surgeries for the last 18 months. The public consultation meeting was well publicised through press coverage. Notices were placed in the public notice section of the EDP and Evening News.
6.1.5 Consideration of alternatives to closing Valley Road Surgery: Costessey Medical Practice is no different to a number of other GP surgeries that cover large areas. The plans to amalgamate the two Costessey Practices into one large, state of the art health centre is in accordance with government and NHS Norfolk’s wishes for a growth in “one stop” clinics.
From the Costessey Medical Practices perspective, the continuation of a main and branch surgery would be an inefficient use of resources, requiring a duplication of staff, equipment, telephones and computers etc. The GP Practice is in its self a small business and decisions made have to be in the interest of the Practice population and also the partners. Over the past 5 years the Practice has explored and evaluated at least 8 different sites.
7 CONCLUSION
7.1 The local Overview and Scrutiny Committee, via this report has now been formally informed of the process surrounding Valley Road, branch surgery closure.
7.2 A meeting will be held between the Costessey Medical Practice, Concerned Green Party City Councillors and NHS Norfolk to discuss concerns and possible solutions (revised date to be agreed).
BP/NC February 2010
Norfolk Health Overview and Scrutiny Committee 4 March 2010 Item no 11
Norfolk Health Overview and Scrutiny Committee
ACTION REQUIRED Members are asked to suggest issues for the forward work programme that they would like to bring to the committee’s attention, using the attached form. Members are also asked to consider the current forward work programme:- whether there are topics to be added or deleted, postponed or brought forward; to agree the briefings, scrutiny topics and dates below.
Proposed Forward Work Programme 2010
Meeting Briefings/Main scrutiny topic/initial review of topics/follow- Administrative dates ups business 2010 15 Apr 2010 Urgent and Emergency Services in Norfolk – update reports from NHS Norfolk, the Norfolk and Norwich University Hospitals NHS Foundation Trust and the Queen Elizabeth Hospital NHS Trust on urgent and emergency care strategies in Norfolk in the light of rising demand.
Intermediate Care Implementation Monitoring Group – update report
How We Manage Death and Dying - a report from NHS Norfolk and NHS Great Yarmouth and Waveney on implementation of NICE guidance on end of life care for cancer sufferers (which should be fully implemented by December 2009).
27 May 2010 Improving Access to Psychological Therapies – a progress report from NHS Norfolk and NHS Great Yarmouth and Waveney on implementation of IAPT.
The Effects of Housing on Physical and Mental Health - an update from the Local Area Agreement Housing Indicator Lead on progress with implementing the accepted recommendations of the NHOSC report (Nov 2008).
15 July 2010 Respite Services – Short Breaks for Carers – joint commissioners NHS Norfolk, NHS Great Yarmouth and Waveney and Adult Social Services report to Committee on progress in developing the carers’ service through joint commissioning.
Older People’s Mental Health – Dementia – Norfolk and Waveney Mental Health NHS Foundation Trust report to Committee on progress in developing its dementia services, including bed usage statistics.
NOTE: These items are provisional only. The OSC reserves the right to reschedule this draft timetable.
Scrutiny being done by working groups of NHOSC
Intermediate Care — implementation monitoring group – due to give a progress report to NHOSC on 15/4/10
Provisional dates for update / briefing reports to the Committee 2010
?? – Out of Hours District Nursing – a report to Committee from NHS Norfolk and the East of England Ambulance Trust on their plans following the review of out of hours services, which is due to be completed by the end of March 2010. Norfolk LINk to prompt the Committee at the appropriate time to ask for this report.