Health Overview and Scrutiny Committee
Committee Room 1, Wednesday, 09 10:30 County Hall, November 2016 Chelmsford, Essex PLEASE NOTE THERE WILL BE A PRIVATE PRE-MEETING FOR ALL HOSC MEMBERS COMMENCING AT 9:30 IN COMMITTEE ROOM 6
Quorum: 4 Membership : Councillor J Reeves Chairman Councillor D Blackwell Councillor K Bobbin Councillor J Chandler Councillor P Channer Councillor M Fisher Councillor R Gadsby Councillor K Gibbs Councillor D Harris Vice-Chairman Councillor R Howard Councillor A Naylor Councillor A Wood Vice-Chairman
Co-opted Non-voting members: Chelmsford City Councillor M Sismey Harlow District Councillor W Forman Uttlesford District Councillor S Harris
For information about the meeting please ask for: Graham Hughes, Scrutiny Officer Fiona Lancaster, Committee Officer Telephone: 033301 34573 Email: [email protected] www.essex.gov.uk/scrutiny
Page 1 of 130 Essex County Council and Committees Information
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The agenda is also available on the Essex County Council website, www.essex.gov.uk From the Home Page, click on ‘Your Council’, then on ‘Meetings and Agendas’. Finally, select the relevant committee from the calendar of meetings.
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If you are unable to attend and wish to see if the recording/webcast is available you can visit this link www.essex.gov.uk/Your-Council any time after the meeting starts. Any audio available can be accessed via the ‘On air now!’ box in the centre of the page, or the links immediately below it.
Page 2 of 130 Part 1 (During consideration of these items the meeting is likely to be open to the press and public)
Pages
1 Membership
2 Apologies and Substitution Notices The Scrutiny Officer to report receipt (if any).
3 Declarations of Interest To note any declarations of interest to be made by Members in accordance with the Members' Code of Conduct.
4 Minutes 7 - 16 To approve the draft minutes of the meeting held on Wednesday 15 September 2016.
5 Questions from the Public A period of up to 15 minutes will be allowed for members of the public to ask questions or make representations on any item on the agenda for this meeting. On arrival, and before the start of the meeting, please register with the Committee Officer.
6 Colchester Hospital/Ipswich Hospital merger 17 - 18 To consider the report (HOSC/57/16).
7 Sustainability and Transformation Plans (STPs)/Joint 19 - 22 working To consider the report (HOSC/58/16).
8 Success Regime 23 - 28 To note the progress report (HOSC/59/16).
9 Princess Alexandra Hospital Hospital, Harlow 29 - 32 To consider the report (HOSC/60/16).
10 North East London Foundation Trust - Inspection report 33 - 40 To consider the report (HOSC/61/16).
11 East of England Ambulance Service - Inspection report 41 - 44 To note the report (HOSC/62/16).
Page 3 of 130 12 Mental Health Strategy 45 - 60 To consider the report (HOSC/63/16).
*** LUNCH BREAK - RECONVENE AT 2.15 PM
13 Autism services in Essex 61 - 90 To consider the report (HOSC/64/16).
14 Joint Committee - Complex urological cancer surgery 91 - 96 update To note the report (HOSC/65/16).
15 Joint Committee - PET CT scanner for South Essex 97 - 102 To note the report (HOSC/66/16).
16 Task and Finish Group looking at Mental Health 103 - 108 Services for Children and Young People To consider the report (HOSC/67/16).
17 NHS England - Regional specialist commissioning 109 - 114 update To consider the report (HOSC/68/16).
18 General update 115 - 126 To consider the report (HOSC/69/16) and accompanying appendix.
19 Work programme 127 - 130 To consider the report (HOSC/70/16).
20 Date of Next Meeting To note that the next meeting will be held at 10.30 am on Wednesday 14 December 2016, in Committee Room 1, County Hall.
21 Urgent Business To consider any matter which in the opinion of the Chairman should be considered in public by reason of special circumstances (to be specified) as a matter of urgency.
Exempt Items (During consideration of these items the meeting is not likely to be open to the press and public)
To consider whether the press and public should be excluded from the meeting during consideration of an agenda item on the grounds that it involves the likely disclosure of exempt information as specified in Part I of Schedule 12A of the
Page 4 of 130 Local Government Act 1972 or it being confidential for the purposes of Section 100A(2) of that Act.
In each case, Members are asked to decide whether, in all the circumstances, the public interest in maintaining the exemption (and discussing the matter in private) outweighs the public interest in disclosing the information.
22 Urgent Exempt Business To consider in private any other matter which in the opinion of the Chairman should be considered by reason of special circumstances (to be specified) as a matter of urgency.
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Page 6 of 130 Thursday, 15 September 2016 Minute 1 ______Minutes of the meeting of the Health Overview and Scrutiny Committee, held in Committee Room 1 County Hall, Chelmsford, Essex on Thursday, 15 September 2016
Present: County Councillors present: J Reeves (Chairman) K Gibbs K Bobbin R Howard P Channer A Naylor A Durcan C Sargeant M Fisher A Wood (Vice-Chairman) Borough/District Councillors present: M Sismey (Chelmsford City Councillor) W Forman (Harlow District Councillor)
Also in attendance: Hannah Fletcher (Healthwatch Essex) Barbara Herts, Director for Integrated Commissioning & Vulnerable People (for agenda item 6)
The following officers were present in support throughout the meeting: Sophie Campion - Committee Officer Graham Hughes - Scrutiny Officer
1 Membership The Committee considered report (HOSC/51/16) setting out changes in the membership of the Committee.
Following a recent change in Cabinet appointments by the Leader at Braintree District Council, Councillor Jo Beavis was no longer a Cabinet Member at that Council. As a result, the HOSC had been notified that she was no longer put forward as Braintree District Council's nomination on the Essex HOSC. Following this notification it was the Chairman's intention not to seek a replacement due to the impending County Council Elections.
The Chairman and Committee wished to thank Councillor Beavis for her work and contribution to the HOSC. It was agreed that the Chairman would write to Councillor Beavis on behalf of the Committee to thank her.
It was Resolved that:
1. The HOSC accepts the withdrawal of the nomination of Councillor Beavis to serve on the HOSC from Braintree District Council and seeks no replacement. 2. Councillor Beavis is invited to continue to serve on the Task and Finish Group looking at mental health services for children and young people Page 7 of 130 Thursday, 15 September 2016 Minute 2 ______through to the conclusion of its review. 3. Councillor Beavis be thanked for her considerable contribution to the work of the Committee over the last three years;
2 Apologies and Substitution Notices Apologies for absence had been received from County Councillors D Blackwell, substituted by C Sargeant, D Harris, substituted by A Durcan, S Canning and R Gadsby. Apologies were also received from Uttlesford District Councillor S Harris.
3 Declarations of Interest Councillor W Forman declared a code interest as a Registered nurse, employed by Princess Alexandra Hospital, Harlow.
Councillor A Wood declared a code interest as a Governor of the North Essex Partnership University NHS Foundation Trust (NEPFT).
Councillor P Channer declared a code interest as a member of the Maldon Community Services and Community Hospital Project Board.
4 Minutes The minutes of the meeting of the Health Overview and Scrutiny Committee held on 27 July 2016 were approved as a correct record and signed by the Chairman.
5 Questions from the Public There were no questions from the public.
6 Mental Health - Proposed Merger
6a Joint report of the Partnership Trusts The Committee received the joint report of the North Essex Partnership University NHS Foundation Trust (NEP) and South Essex Partnership University NHS Foundation Trust (SEPT) at Appendix B to report HOSC/52/16. The report was introduced to the Committee by Nigel Leonard, Executive Director of Corporate Governance, South Essex Partnership University NHFST. Andy Brogan, Executive Director of Mental Health and the Executive Nurse, South Essex Partnership University NHFST, Christopher Butler, Interim Chief Executive, North Essex Partnership University NHFST and Chris Paveley, Chairman, North Essex Partnership University NHFST were also in attendance for the discussion on the Mental Health proposed merger.
The Committee was advised that this update built on the presentation that they had received on 14th April 2016, outlining that following a key recommendation of the jointly commissioned Essex Strategic Review of Mental Health Commissioning (December 2015), that the NEP and SEPT should consider a merger to become a single Trust. It was considered that there could be substantial benefits for the service user of the Trusts working together. Additionally due to the significant level of financial challenge in the future, a merger could achieve savings of around 3% per year whilst protecting frontline services and remaining sustainable.
Page 8 of 130 Thursday, 15 September 2016 Minute 3 ______A Full Business Case (FBC) would be submitted to NHS Improvement (the regulator) and it was hoped that this would get approval early next year. The Trusts had been working together to create the FBC and some of the key developments were highlighted:
The new merged organisation will span four Sustainability & Transformation Plans (STPs) (three of them covering parts of Essex) which are new for this financial year. The Trusts were in close discussion with the STPs to see how plans develop. Work on the merger was developing in close discussion with commissioners, who were supportive of the document. The Trusts were also working closely with Essex County Council. This was feeding into work on the future clinical model and benefits. In terms of identifying risks and issues for the merger, nothing significant had been identified. Some of the bigger risks were that not all services had been covered by the recent CQC inspection, so more attention was being paid to those areas; there was a recognition of the challenging financial positions of both Trusts and this was being carefully looked at in terms of programmes going forward and protecting frontline services.
It was confirmed that the timetable was broadly on track. An interim Board was required to be appointed by the 1st November 2016. The Interim Board would then lead an application process for members of the new Trust. The new Trust would come into being on 1st April 2017 and the Interim Board would remain in place until a permanent Board had been appointed. There were some limitations in the legislation with regard to mergers rather than acquisitions, one of which was that a Board could not be appointed until April 2017.
6b Mental Health Joint Commissioners report The Committee considered the Joint Commissioner preparation/issues for proposed mental health trust merger report at Appendix A to report HOSC/52/16. Sam Hepplewhite, Chief Officer, North East Essex CCG and Sipho Mlambo, Senior Commissioning Manager (Mental Health), Castle Point and Rochford CCG introduced the report to the Committee.
In the Commissioners' view the two Trusts coming together into a merger was in line with the commissioning model. The Essex Commissioners, including Essex County Council, had agreed to an Essex-wide approach to future mental health commissioning. Transformation was starting before the merger was due to happen in April 2017. It was considered positive that clinicians had been engaged early in the process. High level risks had been outlined and there was work on- going to mitigate them. The Commissioners acknowledged that they needed to get their own respective organisations in a strong position to support the merged Trust going forward.
It was explained that in terms of the national context, there was a lot of ambition in the 'Five Year Forward View' and, with many services such as crisis care management, there was a need to move forward at pace. With the significant transformation within the landscape of mental health services it was an opportune time to be doing this and there would be many opportunities going forward.
Page 9 of 130 Thursday, 15 September 2016 Minute 4 ______
6c Committee's consideration of the Proposed Merger The Committee received report HOSC/52/16 with appendices and based on the presentations by the Partnership Trusts and Commissioners, the Committee focused on six key lines of enquiry:
Leadership and Ownership Merger Finance Performance and Quality Communication Culture and Staffing
Leadership and Ownership The key line of enquiry was to ensure that there is strong leadership and direction in place in both Trusts to drive a successful merger. In response to Members' questions the following information was provided:
Both Trusts still have a responsibility to continue providing their current services, however they were now working closely together in a leadership function where appropriate. Whilst still currently operating as separate legal entities, every opportunity was being taken for staff to see the leadership of both Trusts together. Formal joint committees were structured so that both organisations were fully integrated. A Project Board had been established with Nigel Leonard as the Lead Executive for the merger programme. Representatives from both Trusts at executive and non-executive level were on the Board. Moving forward the sustainability of services was the focus. Clinicians had already started working together in some areas which was an initial success. At a strategic level there were a number of workshops and discussions on-going and nothing was being developed without social care colleagues being involved. It was not possible to integrate the contracts yet, but in the future there would be a move to a single contract. The Essex County Council Social Care team were working hard to integrate and align the commissioning. The 'Five Year Forward View' was shaping their strategy going forward and was available in draft form from September 2016. Discussions around practical complexities were on-going with the Project Board. It was recognised by the Trusts that effective services could not be provided without the critical input of colleagues within Social Care. Other areas of social inclusion such as housing and employment were also being considered and the definition of partnerships was being broadened. The aim was to learn from best practice within the two Trusts to shape services and re-define future services to provide a more comprehensive offer. There was a critical issue around choosing models as the organisation develops but the most important aspect of choosing models for the future was to do this in partnership. The aim was also to have the same model across Essex. There would need to be joint agreement as to the pace of implementing change and it was noted that there were no pressing financial issues with the pace of change.
Page 10 of 130 Thursday, 15 September 2016 Minute 5 ______
It was recognised that staff would need to have a sense of belonging to the new organisation. As part of the due diligence process the Trusts had worked with external partners to consider the cultures within both Trusts and there were some differences. Some cultural aspects would carry through to the new organisation and some would be modified. The independent external view was considered helpful with taking this forward. There was recognition nationally regarding the need to improve access to psychological services and the offer was increased each year. Early intervention was important. How services could be delivered closer to people within a locality was being considered along with offering services more quickly to aid recovery and continuing the support into the community. The opportunity of training other professionals to provide the service at lower tiers was also being looked at.
Merger The Committee considered what is driving the need for the merger and what will be the impact of it. In response to Members' questions on this line of enquiry the following information was provided:
To ensure consistency the aim was to have one approach to commissioning. The methods of delivering the services may differ due to local need but the overall strategy and outcomes would be the same Essex-wide. It was confirmed that there would be greater emphasis on early intervention, which was a work stream at national and regional level. An example of this was early intervention with psychosis services with broadening access and an increased age band to work with people from an earlier stage. A new set of standards compliant with National Institute for Health and Care Excellence (NICE) standards with early intervention would provide better outcomes. However more funding would be required and a wider discussion on determinants, such as pressures in schools. It was acknowledged that there were complications with the Sustainability and Transformation Plans (STP) process but progress was being made. The Trusts collect data differently, with different clinical systems, but produced a return which was very similar. A determination would need to be made in future about which systems to use going forward, however this was a considerable challenge as both Trusts had invested in their systems. It had been recognised early on in the process there was a risk associated with the systems and the new organisation would need to ensure the initial flow of information before making any decisions. There had been experience of this within acquisitions. A question was raised regarding the risk to patients with changes to the systems, however it was confirmed that in Essex the information exchange was good between systems. The project merger board was considering what systems could co-exist. It was confirmed that the project board consisted of executive technical leads along with non-executive directors. The interim board was being appointed and would have more non-executive than executive directors that report directly back to governors.
Page 11 of 130 Thursday, 15 September 2016 Minute 6 ______
Finance The key line of enquiry was to identify and understand the financial aspects driving the merger and that these are being properly managed. In response to Members' questions the following responses were given:
It was confirmed that the Business Plan and a number of other documents relating to the merger would be going to the Board in November prior to submission to NHS Improvement (NHSI). These were underpinned by a long-term financial model. An assessment process by NHSI colleagues would consider the detail of financial projections for years 1-3. A 2-year contract arrangement would commence in 2017. The contracts would all be in the public domain and both Trusts were committed to being open with documentation. There was also an implementation plan leading up to when a full merger had been achieved. The priority savings would be reducing the boards from two to one, saving frontline services. Transformation was about providing more or the same with a reduced budget. The CCGs were also in a challenging position and there was a close partnership between commissioners and the Trusts. There was a recognition of the financial challenge, however there would be investment in infrastructure where needed. NHS organisations are required to make efficiency savings each year to demonstrate value for money. The national guidance from NHSI was for most organisations to remain sustainable with a savings target of 2-3%. The merger of two boards into one would achieve a saving of around £1million. A 3% saving for the merged Trust would be around £8-10million. To avoid affecting frontline services, carrying out back office functions more efficiently and looking at the utilization of buildings within the estate were being considered. How services are delivered would also be looked at, in some cases combining services or delivering them in a different way could achieve cost improvements and improve services. It was confirmed that in part the merger was driven by savings needs. Looking radically at less senior managers working differently and harder in order to preserve frontline services. It was acknowledged that the commissioners had a major role to play in helping to achieve cost savings. The CCGs have a set budget to work with and decide how to spend on services. There was a statutory obligation to deliver standards without adding to the deficit. It would be important to have a consistent approach regarding commissioning mental health services with a clear focus on outcomes. It was recognised that the commissioners had not been as clear as they could have been in the past. There was a very clear statutory responsibility to balance the books. Interim board members were not receiving any additional money for the role and whilst this was considerable extra work it was time limited. The merger process was costing money but was an investment for saving money in the future and continuing to provide safe, effective services. The Trusts were constantly looking at working differently, improving partnership working to become more efficient and effective. One example given was that one practitioner looking after one service user was much more effective.
Page 12 of 130 Thursday, 15 September 2016 Minute 7 ______
It was explained that both Trusts had been active in cost saving by not replacing certain positions following retirements. Board salaries over a certain level had to receive permission from the NHS. The finances were public records.
Performance and Quality The key line of enquiry was to consider whether planning and processes are in place to maintain high quality services across the Trust during and after the merger. In response to Members' questions the following information was given:
The aim of the merger was to achieve improved outcomes and better patient care. There was recognition that services had not been universally good. Safeguarding and quality were key. It was recognised that there was a risk to doing things at scale and pace. Therefore the immediate focus was on crisis services and getting all clinical services right. The objective was to have a sustainable, high quality service. There was recognition of the need for improved performance. There would be one registered office for the merged Trust. All accommodation would be looked at to rationalise it. The interim board would make a decision on accommodation going forward. One big organisation provided opportunities across areas and services. The importance of engaging with staff on the frontline and service users was recognised.
Communication The key line of enquiry was to ensure that there is good and transparent communication with stakeholders. In response to questions from Members the following information was provided:
There was an active programme in place to keep everyone updated regarding the merger, including the use of websites. Members had been written to and work was being undertaken with service users. Staff were being consulted to help shape the new organisation. There was a whole range of information for staff in both organisations along with scheduled roadshows. As well as attending this HOSC meeting, the Trusts were also attending HOSC meetings at Thurrock and Southend. The Chair of the interim board was also attending stakeholder meetings. Concern was expressed that there had been little interaction with Healthwatch specifically on the merger. The Healthwatch representative welcomed the opportunity to be actively engaged in the process. The Trusts welcomed engagement with Healthwatch going forward.
Culture and Staffing The key line of enquiry was to understand the issues around having two different cultures and that merging them is being properly managed. The following responses were provided to questions from Members:
It was explained that there was an administrative support skill shortage currently in both clinical and non-clinical.
Page 13 of 130 Thursday, 15 September 2016 Minute 8 ______
Vacancies within the Trusts were being controlled to keep any future redundancies to a minimum. It was acknowledged that responsibilities and roles were likely to change and the priority was to keep the staff that were specifically needed in the new organisation. Specialised skills were more difficult to transfer to alternative roles. The Trusts did not anticipate a large number of redundancies. A high cost to the Trusts was using agency staff, both clinical and administrative, and savings of up to 50% could be achieved by filling those posts with permanent staff. It was confirmed that there were HR processes in place to provide protection to staff and to compensate for certain changes to staff roles, such as additional travel. However it was also acknowledged that staff already moved between the organisations in some cases. Members noted that it was important to look after staff through these organisational changes which could be very stressful. To ensure that as a larger organisation it would not be remote from local issues, there would be locality hubs and executives would visit sites and ensure that they were visible to staff. There was recognition of the need to connect with staff in different ways through the communications strategy. The 10 local commissioning organisations also had a role to play as well as engagement with Patient Participation Groups and Healthwatch.
It was agreed that the Trusts would return to a future meeting at the end of the year or early 2017 to provide an update on progress with the merger.
The Chairman on behalf of the Committee thanked the Trusts and Commissioners for attending and wished them well.
7 Complex Urological Cancer Surgery Update The Committee noted report (HOSC/53/16) providing an update on the work of the Joint Committee with Southend and Thurrock Unitaries to review NHS England proposals for the future provision of complex urological cancer surgery in Essex (JHOSC).
Councillor Naylor advised that the draft report would be shared with NHS England in the next week.
8 Positron Emission Tomography (PET) CT Scanner The Committee considered report (HOSC/54/16) and accompanying appendix seeking ratification to set up a Joint Committee with Southend HOSC on a 'Task and Finish Group' basis to consider proposals by NHS England to establish a single site location for a Positron Emission Tomography (PET) scanner for south Essex.
It was agreed that: (i) The Committee ratify actions taken to establish a Joint HOSC with Southend to consider NHS England proposals for a site for a PET CT scanner to serve south Essex. (ii) The HOSC's representation on the Joint Committee would be Councillors J Reeves, K Bobbin, A Wood and K Twitchen. Page 14 of 130 Thursday, 15 September 2016 Minute 9 ______(iii) The Committee noted the draft Terms of Reference in principle.
9 General Update The Committee noted report (HOSC/55/16) and accompanying appendix, providing information on general local health issues and items of interest (section 1) and variations and changes to services that the HOSC has been notified of, usually relating to primary care (section 2).
Members welcomed this localised update and found it very helpful.
A Member raised a local issue regarding Clacton Medical Centre closure and reported that no confirmation had been received as to who would be taking over the centre.
10 Work Programme The Committee noted report (HOSC/56/16) and accompanying appendix setting out the current work programme. It was noted that there was some uncertainty regarding the timing of Sustainability and Transformation Plans (STPs).
11 Date of Next Meeting The Committee noted that the next meeting was due to take place on Wednesday 12 October 2016 at 10.30am in Committee Room 1 (preceded by a private pre- meeting for Members only at 9.30am).
12 Urgent Business There being no urgent business the meeting closed at 12.58pm.
Chairman
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Page 16 of 130 AGENDA ITEM 6
HOSC/57/16
Committee Health Overview and Scrutiny Date 9 November 2016
Information note for HOSC Members
Ipswich Hospital NHS Trust (IHT) and Colchester Hospital University Foundation Trust (CHUFT)
The new long term partnership – patient care at its heart
CHUFT and IHT are embarked on an exciting but testing and challenging journey together and are keen to keep HOSC members in Suffolk and Essex informed about how their new long-term partnership is progressing. The long term partnership (LTP) was a solution developed in response to the recommendations of Professor Mike Richards (Chief Inspector of Hospitals at the CQC). He identified significant change as necessary to address issues raised in a series of poor CQC reports at CHUFT. To take matters forward, Nick Hulme was appointed Chief Executive of CHUFT in addition to his post at IHT and David White now chairs both Boards. However, even without Prof. Richard’s direction, there are many good reasons why the organisations working more closely together makes good sense for residents of Suffolk and NE Essex and offers mutual benefits to both organisations.
Compelling evidence, including struggles on finance, recruitment and the size of catchment areas, tells us that neither of our medium sized organisations is sustainable on its own in the longer term. So a change in the current pattern of healthcare is inevitable. Between our two hospitals we serve 730,000 people with some 8,000 staff. The scale of our new arrangements gives us new opportunities to organise services differently to deliver them more efficiently and with higher quality for patients. We aim through our long term partnership to seize those opportunities and build successful and sustainable healthcare services for all our communities.
The CHUFT/IHT long term partnership and the wider NHS Sustainability and Transformation agenda for Suffolk and North East Essex.
Our developing partnership fits firmly within wider NHS planning for a more sustainable pattern of healthcare for residents of Suffolk and North East Essex - a pattern that is more robust and able to deliver high quality and safe healthcare for residents now, and for generations to come. This planning – to develop a Sustainability and Transformation Plan (STP) for Suffolk and NE Essex - takes account of a range of issues, including those set out in the paragraph above, that make a compelling case for change for IHT and CHUFT. It also recognises that doing nothing in such circumstances is not an option. That is why the Suffolk
Page 17 of 130 and NE Essex STP includes the developing CHUFT/IHT partnership as one its key programmes.
Where we are now – early exploratory phase and seeking HOSC advice
We are now at an early, exploratory phase in our development. This will see us working to gather, test and examine information needed to help identify scenarios for how, and in what form of partnership, we could obtain the best possible benefits for our populations.
While this information gathering period is underway, we are also working to develop a comprehensive communications and engagement plan that will ensure our partners and stakeholders are actively engaged in helping take matters further. We welcome the opportunity to provide regular information updates to HOSC members and would particularly welcome their views and ideas on how best we can make such engagement as meaningful as possible.
Page 18 of 130 AGENDA ITEM 7
HOSC/58/16
Committee Health Overview and Scrutiny Date 9 November 2016 Report by: Graham Hughes, Scrutiny Officer
North East Essex and Suffolk Sustainability and Transformation Plan
Recommended actions:
To finalise future approach, level of oversight and scrutiny towards the development of the local Sustainability and Transformation Plans.
To endorse actions taken to establish a Joint Committee with Suffolk HOSC and approve member representation on it. ______
Background – Sustainability and Transformation Plans
Sustainability and Transformation Plans (STPs) have been established across the country. STPs are NHS England plans to improve the quality and efficiency of local health services through greater integration of local health, social care and other services. STPs are five-year local plans that are likely to lead to proposals for significant changes to the way future health services are provided and located, as part of accelerating the implementation of the NHS five year forward view vision of better health, better patient care and improved NHS efficiency.
NHS providers, CCGs, Local Authorities and other health and care services will take the following factors into account: a) Geography (including patient flow, travel links and how people use services); b) Scale (the ability to generate solutions which will deliver sustainable, transformed health and care which is clinically and financially sound); c) Fit with footprints of existing change programmes and relationships; d) The financial sustainability of organisations in an area; and e) Leadership capacity and capability to support change.
STPs are not coterminous with county borders and, in the case of Essex, cross over adjoining authorities in the north east, west and south of the county (also referred to as ‘footprints’).
1. Suffolk (excluding Waveney) and North East Essex which incorporates the North East Essex Clinical Commissioning Group area;
Page 19 of 130 2. Mid and South Essex which incorporates five Essex clinical commissioning group areas – Mid Essex, Basildon and Brentwood, Castle Point and Rochford, Southend and Thurrock; 3. Hertfordshire and West Essex which incorporates the West Essex Clinical Commissioning Group area.
Whilst strategic plans for STPs were submitted by 21 October, NHS England has indicated their flexibility in the amount of detail that should have been submitted at that time. Instead, the focus may fall on operational plans being developed for year- end. Therefore, for health scrutiny to commence its work in a timely manner it should be considering early engagement on the operational plans now being developed.
The Mid and South Essex has already been subject to some early thought of reconfiguration of some services under the ‘Success Regime’ banner although that has focussed on specific services rather than an ‘all system’ approach.
National guidance has emphasised that STPs should be engaging with health scrutiny and, with the footprints crossing county borders, thought needs to be given as to how the Essex HOSC structures its future ‘ways of working’ to encompass scrutiny of STPs and fulfil its statutory role around an already significant committee work load. To facilitate this the Committee may need to demonstrate how it will be prioritising its future work load.
What has Essex HOSC done so far?
- Essex HOSC has had two public scrutiny sessions this year on the Success Regime (effectively the predecessor to the Mid and South Essex STP) with NHS England with a further one at today’s meeting. - Co-hosted a conference with Healthwatch Essex to discuss ensuring patient engagement in the Success Regime which made recommendations around key principles of good engagement . - The Essex HOSC Chairman and Vice Chairman have met the STP Lead for North Essex and Suffolk. No such engagement yet arranged for West Essex. - A workshop style event is planned in November for the prospective members of the joint scrutiny committee for the North Essex and Suffolk STP - Informal officer discussions have continued (both within ECC and with colleagues at neighbouring authorities) around the appropriate timing for future scrutiny engagement on STPs and opportunities for joint working.
Proposed action 1. To evolve arrangements over the coming months to complement the developing discussions around STPs. The main Essex HOSC has indicated that it wishes to continue to have strategic oversight of all the STPs but there is an opportunity to further investigate and establish joint working
Page 20 of 130 arrangements with regional colleagues via sub-groups initially on a Task and Finish Group basis (i.e. not standing committees, no need to be exactly proportional etc) 2. These sub-groups could develop a joint approach and options for the future scrutiny of their respective STP, plan a future work programme and co-opt any additional representation from districts and the community deemed necessary. They could be formed with a view to potentially becoming standing joint committees if the need is clear further down the line. 3. That actions already taken to establish a Joint Committee with Suffolk (to operate on a task and Finish group basis) to review the Suffolk and North East Essex STP be endorsed and that councillors Erskine (representing People and Families Scrutiny Committee), Harris and Wood be the HOSC’s representatives on such Joint Committee (Councillor Sargeant to be appointed as either a fourth member or substitute member depending on the final numbers and size of the Committee agreed with Suffolk County Council).
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Page 22 of 130
AGENDA ITEM 8
HOSC/59/16
Committee Health Overview and Scrutiny Date 9 November 2016
Progress update for Essex Health Overview and Scrutiny Committee
Mid and South Essex Sustainability and Transformation Plan (STP) and Success Regime
For the meeting of the HOSC on 9 November 2016
Purpose
This paper provides a brief progress update on planning for health and care transformation in mid and south Essex. Following a short recap, the paper presents a summary of current thinking and process, including actions to engage staff, stakeholders and local people.
Quick recap
In 2015, it was announced by the national health regulators that Essex should have the support of a “success regime”. This is a national programme that provides additional expertise and resources to help local leaders plan radical, system-wide changes to sustain health and care for the future. Essex is one of just three areas in the country to work within a success regime.
At the same time, all health and care systems across the country are expected to have a “sustainability and transformation plan (STP)”, which sets out transformational changes over the next five years and the steps to achieve them.
It was agreed that the STP and success regime should cover the same area of mid and south Essex, which includes five of the seven CCGs in Essex, three local authorities, three main hospital trusts, four community and mental health providers, East of England Ambulance Service and some 180 GP practices. The CCG areas of west and north east Essex are preparing their STPs in partnership with Hertfordshire and Suffolk.
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Following a diagnostic review at the end of 2015, the success regime was established with an overall plan by 1 March 2016. Since then, working groups have been gathering evidence and developing proposals for change in two parts of the health and care system:
• Local health and care – including plans for joined up GP, primary, community, mental health and social care, alongside partnerships with voluntary sector and other services • In hospital – including plans for the three main hospitals – Basildon, Broomfield and Southend - to work as one group and look at options to ensure services are sustainable
Work on the STP started in April and two drafts have been submitted to the national regulators, one at the end of June 2016 and one on 21 October 2016. The STP was developed by a working group of representatives from health and care partners. The STP and a public summary of the plan are due to be published later this year.
Difference between the STP and the success regime
The STP provides the overall strategic plan, covering all aspects of health and care from prevention to specialist services, including some strategies that are Essex-wide, such as for mental health and learning disabilities.
The success regime plan is a major part of the STP. It concentrates on the top priority and critical changes required to:
• Sustain the clinical workforce across the health and care system • Configure services in both community and hospital settings to meet rising demands with innovation, best practice and high quality care • Achieve sustainable financial balance by 2020/21
Where we are now
Working groups across the health and care system are developing a business case that will set out how services will join up to improve care and the level of investment that may be required.
At the same time, we have engaged local people with, so far, over 50 stakeholder meetings and 27 discussion workshops with staff and service users. These workshops provide substantial service user insights into what matters to patients and families and what implications need careful consideration in any potential service change.
Once approved, the business case is the basis upon which there would be a full public consultation.
Local health and care workstreams
• The five CCGs and partners are progressing with a range of developments that will place a much greater emphasis on prevention and self-care. This will include ways of identifying those with higher risks and helping them with care plans and preventative care to avoid illness and hospital visits. • Developing partnerships between professionals and services in the community aim to extend what they are able to offer to patients in terms of range of services, time for people and access to urgent care.
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• The proposed plan to achieve the above is through local networks of services around natural communities of between 20,000 and 70,000 people. This could establish around 26 localities of care across mid and south Essex.
In hospital workstreams
• The In hospital work is about maximising the benefits of the three hospitals in Basildon, Chelmsford and Southend working together as a group. The vision is to create top performing local and specialist hospital services that would rank among the best in the country. • The hospital group creates the potential to: o save money by sharing administrative and support functions o create a specialist emergency hospital that would improve the quality of life-saving emergency care, 24 hours a day, 7 days a week o create new centres of excellence for surgery and other treatments that would reduce waiting times and put an end to surgery cancellations o develop other centres of excellence such as for specialist children’s services and high risk births
Developing proposals and preparing for public consultation in 2017
The main changes for consultation in 2017 lie within the In hospital workstream of the Success Regime/STP. Developments in primary and community services will continue to build on health and wellbeing strategies that were already in progress.
No change for existing centres of excellence
Within the emerging models of clinical services the following centres of excellence would remain unchanged: • Cardiothoracic centre at Basildon • Plastics and Burns at Chelmsford • Cancer and Radiotherapy services at Southend
As much care as possible close to where people live
For the majority of hospital care the aim is to provide as much as possible close to where patients live, balanced against potential benefits of consolidating some specialist services. This includes identifying where there is potential to transfer some services to GP surgeries or local health centres, and opportunities to use telemedicine and other technologies to run virtual clinics.
Across the range of hospital services, the majority of what people might need from their local hospital would continue at each hospital site, such as day surgery, outpatient clinics and beds for a short stay for observation and recovery.
All three hospitals would continue to provide an A&E for walk-in patients and for ambulances carrying patients who have been referred by their GP.
There would be assessment units for children, older and frail people and for people who may need surgery. These assessment units would ensure quick access to tests and scans and prompt
Page 253 of 130 treatment, including an overnight stay if necessary, so that most people needing urgent treatment could receive it at their local hospital.
The local hospital would also be able to look after people who need a few days for recovery and rehabilitation following specialist surgery or other treatment, which they may have had in a specialist centre elsewhere.
Specialist roles across the hospital group
In addition to their local hospital role, each of the hospitals could offer more specialist services for the whole of Mid and South Essex. This would help to solve current challenges facing all three hospitals in terms of recruitment and development of the right number and combination of specialists, GPs, nurses, carers and support workers to provide round-the-clock, high quality care.
Further work is ongoing to develop and appraise the potential models and possible combinations across the hospital group.
Engagement with local people
We have so far held public discussion workshops in July, September and October with mixed groups of around 20-75 people per session. These deliberative events have brought together service user representatives with clinical leaders and delivered substantial contributions to the decision-making process.
We will update the Committee on 9 November with further details on service user engagement. In the meantime, the tables below provide a broad view of the common themes and issues raised:
Common themes raised by s ervice users Common themes raised by staff Transport – consider public transport, Travel/transport for both patients and staff patient transport and accommodation People will need more help to cope with Need to work on standardisation to ensure complexity of using different centres consistency. Complex pathways could be more complicated not less Families will need more support Need critical development in information and IT GP access needs to improve Co mmunity and locality capacity – need system-wide working Ambulance – development of operations, Resources to deliver change - support for clinical practice and training staff Patient and public education Patient and public engagement Concerns about recruitment – some Impact of change process on recruitment / comments on benefits of centres of retention excellence
Examples of issues raised by service users Examples of issues raised by staff
Training for staff (dementia highlighted) Community capability and support Link with voluntary sector to improve Invest in training efficiency and productivity
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Whole patient pathway – after care and Keep staff well -informed and listen to views choice after emergency event in terms of developing operational model
Invest in new ways of communicating Clear roles, responsibilities, protocols, accountability Understand behaviour and develop better Build -in needs of vulnerable people and urgent and out of hours care e.g. minors those on low income units close to A&E Value staff Ensure change is attractive to clinicians and other specialists
Current timescales
Since we last presented to the HOSC, we have secured the support of local and national colleagues to allow more time for engagement with clinicians, stakeholders and local people. We are keen to refine proposals with the expertise and experience of as many as possible so that all potential opportunities and implications are considered.
We have therefore set the completion of the pre-consultation business case for early in 2017, in a change from the original plan. The business case will then be considered and assured by the national bodies and, subject to a satisfactory assurance, we will proceed to public consultation.
Further details on the next phase of engagement will be provided on 9 November.
Ends .
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Page 28 of 130 AGENDA ITEM 9
HOSC/60/16 Committee Health Overview and Scrutiny Date 9 November 2016
PRINCESS ALEXANDRA HOSPITAL (HARLOW)
Report by Graham Hughes, Scrutiny Officer Contact details: [email protected] Tel: 03301 34574
The HOSC is requested to: (i) Note that the Princess Alexandra Hospital Trust (PAH) has been placed into Special Measures as a result of the findings of a Care Quality Commission (CQC) inspection report; (ii) Consider the concerns highlighted in the CQC’s report; and (iii) Consider the HOSC’s future approach on this issue and specifically the proposal from the HOSC Chairman on a joint approach with Hertfordshire HOSC. ______
Background
On 19 October 2016, the CQC published an inspection report on PAH. The CQC have rated PAH as inadequate overall due to significant concerns in safety, responsiveness and leadership, and commented that they view that there is an apparent disconnect between the trust board leadership level and the ward level.
The CQC’s full inspection report is available from the following link - https://www.cqc.org.uk/sites/default/files/new_reports/AAAF6797.pdf . The Letter from the Chief Inspector of Hospitals, which summarises the report, is attached as an Appendix.
In consultation with the HOSC Chairman and the Herts HOSC Chairman, the following approach is proposed:
1. That the two HOSC’s work together on this so as to not duplicate effort and, just as importantly, streamline the local authority scrutiny process for PAH at a time when they are already having significant regulatory oversight; 2. That the HOSCs find an appropriate level of oversight and scrutiny cognisant of the significant regulatory oversight now already being faced by PAH; 3. That, in view of the greater proportion of PAH patients being from Essex, that the Essex HOSC leads on this and that Herts HOSC be invited to send a small number of representatives to join it when discussing this issue. 4. That engagement with the Trust should start in December or January 2017. Page 29 of 130 APPENDIX
CQC Overall rating for PAH - Inadequate Are services at this trust safe? Inadequate Are services at this trust effective? Requires improvement Are services at this trust caring? Good Are services at this trust responsive? Inadequate Are services at this trust well-led? Inadequate
Letter from the Chief Inspector of Hospitals (dated 16 October 2016)
We carried out a comprehensive inspection on 28 and 29 June 2016 as part of our regular inspection programme. This inspection was carried out as a comprehensive follow up inspection to assess if improvements have been made in all core services since our last inspection in July 2015.
The Princess Alexandra Hospital NHS Trust is located in Harlow, Essex and is a 460 bedded District General Hospital providing a comprehensive range of safe and reliable acute and specialist services to a local population of 350,000 people. The trust has 5 sites; Princess Alexandra Hospital, St Margaret’s Hospital, Herts and Essex Hospital, Cheshunt Community Hospital and Rectory Lane Clinic. At our inspection on 28 and 29 June 2016, we inspected The Princess Alexandra Hospital. On our unannounced inspection on 2 and 5 July 2016, we inspected The Princess Alexandra Hospital. We reviewed the service provided at the Rectory Lane Clinic and found that this location did not require registration. The trust informed us that they would be applying to remove this location.
During this inspection, we found that there had been deterioration in the quality of services provided since our previous inspection in 2015. There was a lack of management oversight and lack of understanding of the detail of issues which we observed. We found that the trust had significant capacity issues and was having to reassess bed capacity at least three times a day. This pressure on beds meant that patients were allocated the next available bed rather than being treated on a ward specifically for their condition. We found that staff shortages meant that wards were struggling to cope with the numbers of patients and that staff were moved from one ward to cover staff shortages on others. The trust sees on average around 350 patients a day in its emergency department (ED). We have rated the Princess Alexandra Hospital location as inadequate overall due to significant concerns in safety, responsiveness and leadership, with an apparent disconnect between the trust board leadership level and the ward level. It was evident that the trust leaders were not aware of many of the concerns we identified through this inspection. However, we found that the staff were very caring in all areas. We have rated the maternity and gynaecology service as outstanding overall.
Our key findings were as follows: • Shortages of staff across disciplines coupled with increased capacity meant that services did not always protect patients from avoidable harm, impacted upon seven day provision of services and meant that patients were not always treated in wards that specialised in the care their condition. • The disconnect between ward staff and the matron level had improved, however some cultural issues remained at this level Pagewhich 30 required of 130 further work. • The relationship between staff and the site management team had improved, though this was still work in progress and the trust acknowledged further work was required here. • Agency staff did not always receive appropriate orientation, or have their competency checks undertaken for IV care for patients on individual wards. This had improved by the time our unannounced inspection concluded. • The storage, administration and safety of medication was not always monitored and effective. • Information flows and how information was shared to trust staff were not robust. This meant that staff were not always communicated to in the most effective ways. • The staff provided good care despite nursing shortages. • There were poor cultural behaviours noted in some areas, with some wards not declaring how many staff or beds they had overnight to try and ease the workloads. This was a result of constant pressure on the service activities. • The mortuary fridges had deteriorated since our last inspection and were no longer fit for purpose. These were replaced during our unannounced inspection to ensure they provided an appropriate environment for patients. • Across surgery, there were notable delays in answering call bells on surgical wards including Kingsmoor and Saunders ward.
Gynaecology inpatient care had not improved, but declined, since our previous inspection. The inpatient gynaecology service, which was operated through surgery, was not responsive to the needs of women.
We saw several areas of outstanding practice including: • The ward manager for the Dolphin children’s ward had significantly improved the ward and performance of children’s services since our last inspection • The tissue viability nurse in theatres produced models of pressure ulcers to support the education and prevention of pressure ulcer development in theatres. This also helped to increase reporting. • The improvement and dedication to resolve the backlog and issues within outpatients was outstanding. • The advanced nurse practitioner groups within the emergency department were an outstanding team, who worked to develop themselves to improve care for their patients. • The gynaecology early pregnancy unit and termination services was outstanding and provided a very responsive service which met the needs of women. • The outcomes for women in the maternity service were outstanding and comparable with units in the top quartile of all England trusts. • MSSA rates reported at the trust placed them in the top quartile of the country. • The permanent staff who worked within women’s services were passionate, dedicated and determined to deliver the best care possible for women and were outstanding individuals. • The lead nurse for dementia was innovative in their strategy to improve the care for people living with dementia.
However, there were also areas of poor practice where the trust needs to make improvements. Importantly, the trust must: • Ensure that fit and proper persons processes are ratified, assessed and embedded across the trust board and throughout the employment processes for the trust. • Ensure that the risk management processes, including board assurance processes, are reviewed urgently to enable improved management of risk from ward to board. Page 31 of 130 • Ensure that safeguarding children’s processes are improved urgently and that learning from previous incidents is shared. • Ensure that staff are provided with appraisals, that are valuable and benefit staff development. • Improve mandatory training rates, particularly around (but not exclusive to) safeguarding children level 3, moving and handling, and hospital life support. • Ensure that trust staff are knowledgeable and provide care and treatment that follows the requirements of the Mental Capacity Act 2005.
These are the areas the trust should improve on: • Review the priority improvement programme to ensure that the mortuary is refurbished. • Review the cleaning schedules for the public areas throughout the hospital, and review the disposal of rubbish arrangements from the portering area to reduce the impacts of waste build up. • Review the processes of how ward to board escalation is embedded to ensure that all concerns are captured where possible.
As a result of the findings from this inspection I have recommended to NHS Improvement that the trust be placed into special measures. It is hoped that the trust will make significant improvements through receipt of support from the special measures regime prior to our next inspection.
Professor Sir Mike Richards Chief Inspector of Hospitals
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The NHS Choices website allows patients and service users to rate their experience of NHS providers and to leave comments. The link below takes you to the part of the site that receives comments and ratings on Princess Alexandra Hospital. http://www.nhs.uk/Services/hospitals/ReviewsAndRatings/DefaultView.aspx?id=RQWG0
Page 32 of 130 AGENDA ITEM 10
HOSC/61/16
Committee Health Overview and Scrutiny Date 9 November 2016 Report by: Graham Hughes, Scrutiny Officer
North East London Foundation Trust – Inspection report
Action required:
The Committee is asked to consider its approach to monitoring improvement actions to be taken by NELFT cognisant of the role and focus of the Task and Finish Group already looking at mental health services for children and young people.
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On 27 September 2016 the Care Quality Commission issued a report on an inspection of North East London Foundation Trust (NELFT) carried out in April 2016. The Trust was rated as Requires Improvement for being Safe, Effective, Responsive and Well-led. It was rated Good for Caring.
NELFT are the provider of emotional wellbeing and mental health services (EWMHS) for children and young people in Essex.
A copy of the CQC press release is attached.
Page 33 of 130
Page 34 of 130 APPENDIX
26 September 2016
North East London NHS Foundation Trust Requires Improvement says CQC
Embargoed until 00:01 hours on Tuesday 27 September 2016
England’s Chief Inspector of Hospitals has rated North East London NHS Foundation Trust as Requires Improvement.
The trust was rated Requires Improvement for being Safe, Effective, Responsive and Well-led. It was rated Good for Caring following the inspection in April. You can read the report in full at www.cqc.org.uk/provider/RAT
North East London NHS Foundation Trust provides community health and mental health services in Essex and across the North East London Boroughs of Barking and Dagenham, Havering, Redbridge and Waltham Forest. It provides care and treatment for a population of about 1.75million and employs around 6,000 staff.
Care Quality Commission inspectors identified a number of areas where the trust must improve services as a priority. The child and mental health wards at the Brookside unit were a particular concern, says the report, in relation to staffing, restrictive practices, lack of incident reporting and lack of recovery orientated care planning.
Shortly after the inspection, the trust took action to temporarily close the Brookside unit after CQC issued a Warning Notice requiring significant improvements. It is scheduled to reopen this month.
Inspectors found that risks to mental health patients were not always dealt with properly. The trust had failed to ensure that the risks to patients at risk of suicide from ligature anchor points were identified, and made safe.
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In the community health services there were major staffing shortages and recruitment challenges across all staff groups and localities. There were high caseloads for staff, high use of agency and bank staff, all which had an impact on the delivery of the services.
There was though, a well-established patient experience partnership group with direct links to the board to enable strategic developments for people using services.
The diabetes team in the Essex community health adults’ service had developed a number of initiatives to meet the needs of the local population more effectively. The team provided Skype appointments and telephone assessments depending on patient needs, and texted blood results to patients to spare them an appointment.
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals and CQC lead for mental health, said: “There are many areas where North East London NHS Foundation Trust needs to improve. Also, the trust has not demonstrated that it learns from adverse incidents and has not taken appropriate steps across all of the mental health services to ensure that risks to patients are minimised.
“The trust must provide more training to staff on some important areas. In particular, I am concerned that the Mental Health Act was not part of the mandatory training for all staff in the mental health services. This is particularly important for staff who work regularly with patients who are detained under the Act. We also found that there was a lack of robust induction or training for the trust governors, which meant they might not be as effective as they could be in their role.
“However, directors and managers demonstrated commitment and enthusiasm to the trust and spoke passionately of the work being undertaken to develop services.
“The trust had taken positive action in response to the recent NHS staff survey to involve and engage staff more in the development of the trust. There was a well-established patient experience partnership group with direct links to the board to enable strategic developments for people using services.”
The report identifies a number of areas where the trust must improve which include:
• The trust must reduce the use of restraint and prone restraint • It must ensure mental health staff are properly trained • The trust must ensure consistent patient access to psychological therapies • No restrictive practices throughout the child and adolescent mental health wards on Brookside unit • The trust must ensure that patients at Brookside unit are not secluded without proper safeguards in place • Searching of patients at the Brookside unit are carried out in accordance with a clear policy.
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Name of provider North East London Foundation Trust.
Safe Effective Caring Responsive Well-led
Requires Requires Requires Requires Provider by key question Good Improvement Improvement Improvement Improvement
Requires Overall provider rating Improvement
Name of location North East London Foundation Trust.
Safe Effective Caring Responsive Well-led Overall
Community health services for Requires Good Good Good Good Good adults Improvement Community health services for Requires Requires Requires Requires Requires children, young people and Good Improvement Improvement Improvement Improvement Improvement families
Page 37 of 130 Community health inpatient Requires Good Good Good Good Good services Improvement
Not Not Not Not Not Not End of life care Applicable Applicable Applicable Applicable Applicable Applicable
Not Not Not Not Not Not Community dental services Applicable Applicable Applicable Applicable Applicable Applicable
Requires Requires Requires Requires Requires Overall Good Improvement Improvement Improvement Improvement Improvement
Name of location North East London Foundation Trust
Safe Effective Caring Responsive Well-led Overall
Acute wards for adults of Requires Requires Requires Requires Requires working age and psychiatric Inadequate Improvement Improvement Improvement Improvement Improvement intensive care units (PICU's) Long stay/rehabilitation mental health wards for working age Good Good Good Good Good Good adults
Forensic inpatient / secure wards Good Good Good Outstanding Good Good
Page 38 of 130 Child and adolescent mental Requires Inadequate Inadequate Inadequate Inadequate Inadequate health wards Improvement
Wards for older people with Requires Requires Requires Requires Requires Good mental health problems Improvement Improvement Improvement Improvement Improvement
Wards for people with a learning Good Good Good Good Good Good disability or autism
Community-based mental health Requires Good Good Good Good Good services for adults of working age Improvement
Mental health crisis services and Requires Good Good Good Good Good health based places of safety Improvement Specialist community mental Requires health services for children and Good Good Good Good Good Improvement young people
Community-based mental health Requires Good Good Good Good Good services for older people Improvement Community mental health Requires services for people with a Good Good Good Good Good Improvement learning disability or autism
Requires Requires Requires Requires Requires Overall Good Improvement Improvement Improvement Improvement Improvement
Page 39 of 130 Notes for editors:
During the announced inspection visit from the 4 – 8 April, and unannounced inspection on the 14 April 2016 the inspection team visited 62 wards, teams and clinics and spoke with 265 patients and people using services or their relatives and carers, either in person or by phone
Inspectors visited all of the trust’s hospital locations and a sample of community health services. They inspected all wards across the trust including adult acute services, the psychiatric intensive care unit, community hospitals, the forensic ward, health centres and older people’s wards.
About the Care Quality Commission The Care Quality Commission (CQC) is the independent regulator of health and social care in England. We make sure health and social care services provide people with safe, effective, caring, well-led and responsive care, and we encourage care services to improve. We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.
Page 40 of 130 AGENDA ITEM 11
HOSC/62/16
Committee Health Overview and Scrutiny Date 9 November 2016 Report by: Graham Hughes, Scrutiny Officer
East of England Ambulance Service – Inspection report
Recommended actions:
To note the regional health scrutiny meeting held in response to the Inspection Report on the East of England Ambulance Service issued by the Care Quality Commission and consider future approach.
Background
The Care Quality Commission (CQC) undertook an announced inspection of the East of England Ambulance Service between 4th and 8th April 2016, and unannounced inspections on 19th April 2016. Their inspection report was published in August 2016 and can be accessed by following this link: http://www.cqc.org.uk/sites/default/files/new_reports/AAAF7381.pdf
A copy of the letter from the Chief Inspector of Hospitals, which provides a summary of the regulatory issues identified is attached as an appendix.
Three core services were inspected and rated as follows: a. Emergency Operations Centres - Good b. Urgent and Emergency Care including the Hazardous Area Response Team (HART) – Requires Improvement c. Patient Transport Services – Requires Improvement
Due to the geographical spread of the service, regional scrutiny colleagues proposed that an informal meeting be held for regional health scrutiny committee Chairmen to discuss these regulatory concerns raised by the CQC with the ambulance trust. The Essex HOSC Chairman agreed that Essex HOSC should participate and Councillor Harris, as Vice Chairman of the HOSC, attended the meeting hosted by Suffolk County Council earlier this month.
Discussion on the day included:
A stronger focus on leadership and governance and on promoting the health and wellbeing of staff
Page 41 of 130 Corrective actions already taken and being planned; Initiatives to improve hospital handovers Prevention work and re-ablement to encourage emergency avoidance Meeting national performance targets and response times Staff capacity, training and levels of demand. Staff wellbeing and whistleblowing. The level of involvement in the Sustainability and Transformation Plans being developed across the region.
Page 42 of 130 APPENDIX East of England Ambulance Service NHS Trust
Overall rating for this ambulance location: Requires improvement Emergency and urgent care services Requires improvement Patient transport services (PTS) Requires improvement Emergency operations centre Good ------
Summary of findings Letter from the Chief Inspector of Hospitals
The East of England Ambulance Service NHS Trust (EEAST) is one of 10 ambulance trusts in England providing emergency medical services to Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk; an area which has a population of around 6 million people over 7500 square miles. The trust employs around 4000 staff and 1500 volunteers who are based at more than 130 sites including ambulance stations, emergency operations centres (EOCS) and support offices across the East of England.
The main role of EEAST is to respond to emergency 999 calls, 24 hours a day, 365 days a year. 999 calls are received by the emergency operation centres (EOC), where clinical advice is provided and emergency vehicles are dispatched if required. Other services provided by EEAST include patient transport services (PTS) for non- emergency patients between community provider locations or their home address and resilience services which includes the Hazardous Area Response Team (HART).
Every day EEAST receives around 2600 calls from members of the public dialling 999. The service provided by EEAST is commissioned by 19 separate Clinical Commissioning Groups with one of these taking the role as co-ordinating commissioner.
Our announced inspection of EEAST took place between 4th and 8th April 2016 with unannounced inspections on 19 th April 2016. We carried out this inspection as part of the CQC’s comprehensive inspection programme.
We inspected three core services: • Emergency Operations Centres • Urgent and Emergency Care including the Hazardous Area Response Team (HART). • Patient Transport Services
Our key findings were as follows: • The trust was under significant pressure and was failing to meet performance standards and targets for response to emergency calls. • The chief executive had been in post for approximately 7 months and was developing new models of care and new strategies to address performance and recruitment concerns. These were yet to reach fruition.
Page 43 of 130 • Resources were frequently unavailable as they were unable to hand over patients to acute providers in a timely way. This occurred throughout or inspection. • There was ongoing significant issues in recruitment of paramedics across the trust with particular ‘hotspots’ in certain areas including Norfolk and Cambridgeshire. • The trust had identified new models of workforce development and new roles to support the service. This was in the process of consultation and implementation during our inspection. • There was variation across the trust in many areas including governance, medicines management and infection control. • The emergency operations centres were recruiting clinical staff into ‘clinical hubs’ to dramatically improve the number of patients treated over the telephone or signposted to more appropriate services. • All staff were passionate about providing the best possible service to patients. We consistently observed staff to be caring and compassionate and concerned for the welfare of patients. • There were low levels of mandatory training and many staff were not equipped with the skills to care for people living with dementia and mental health problems and a poor knowledge of the Mental Capacity Act 2005.
However, there were also areas of poor practice where the trust needs to make improvements
Importantly, the trust must: • Improve performance and response times for emergency calls. • Ensure that there are adequate numbers of suitable skilled and qualified staff to provide safe care and treatment • Ensure staff are appropriately mentored and supported to carry out their role including appraisals. • Ensure staff complete mandatory training (professional updates). • Ensure that incidents are reported consistently and learning fed back to staff. • Ensure that all staff are aware of safeguarding procedures and there is a consistent approach to reporting safeguarding. • Ensure that medicines management is consistent across the trust and that controlled medicines are stored and managed according to regulation and legislation. • Ensure that all vehicles and equipment are appropriately cleaned and maintained. • Ensure all staff are aware of their responsibilities under legislation including the Mental Capacity Act 2005. • Ensure all staff are aware of their responsibility under Duty of Candour requirements. • Ensure records are stored securely on vehicles.
In addition the trust should: • The trust should consider how all risks associated with PTS can be captured and reviewed on the risk register. • The trust should improve the numbers of patients offered hear and treat services.
Professor Sir Mike Richards Chief Inspector of Hospitals
Page 44 of 130 AGENDA ITEM 12
HOSC/63/16
Committee Health Overview and Scrutiny Date 9 November 2016
Essex, Southend and Thurrock Mental Health and Wellbeing Strategy 2017-21
Report by: Barbara Herts, Director for Commissioning Mental Health
Contact details : [email protected] Tel: 033301 31145
1. Purpose
Cllr Butland reported plans for a new mental health strategy at the HOSC meeting on 1 June. The Essex, Southend and Thurrock Mental Health and Wellbeing Strategy 2017-21 will set out an overarching vision for mental health in Greater Essex, identify outcomes and drive a transformation in mental health care and support. It is being co-produced by Essex, Southend and Thurrock Local Authorities with the seven Essex CCGs, consulting with a range of partners, including experts by experience.
2. Background
The development of the strategy has been driven and framed by key developments, both nationally and in Essex, including:
- The recommendations of an independent review of adult mental health in Essex by Boston Consultancy, produced in September 2015, and which include a recommendation for a shared, pan-Essex strategy and integrated commissioning arrangements;
- The launch in November 2015 of the Greater Essex Emotional Wellbeing and Mental Health Service for Children and Young People;
- The Trust Merger and taking the opportunity to reshape Adult Mental Health Services ;
- The development of Essex’s Future in Mind Transformation Plan for children and young people (Open up, Reach Out ) – a revised version is in preparation for submission to NHS England in October;
- The development of a Greater Essex dementia strategy , which is currently being finalised and we expect to be in governance by January 2017;
Page 45 of 130
- The implementation and writing of a Pan Essex Suicide Prevention Strategy , which is currently in development, with the expectation it will be ready to launch with the Mental Health and Wellbeing Strategy in February 2017;
- The need to ensure that mental health is a priority for Essex’s three Sustainability and Transformation Plans (STPs) and for the Success Regime;
- The national focus on and support for mental health transformation, notably NHS England’s Five Year Forward View for Mental Health (February 2016).
The HOSC will also be aware of proposals for merger of Essex’s two mental health trusts (SEPT and NEPT), as discussed at its meeting on 15 September, and of the wider financial and quality challenges that these proposals are seeking to address.
3. Update
A suite of three strategy documents has been produced in draft form, which will together comprise the Essex, Southend and Thurrock Mental Health and Wellbeing Strategy 2017-21 :
(1) a ‘strategy on a sheet’ to provide an accessible overview; (2) a short version for a wider audience; and (3) the full strategy, primarily for system leaders and professionals.
It is anticipated that these will be launched as part of a new on-line, all age mental health hub and resource for Essex, alongside other key documents (e.g., Dementia Strategy, Open up, Reach Out strategy, Mental Health JSNA and Pan-Essex Suicide Prevention Strategy).
Partners have also agreed commissioning intentions for 2017-18 and will produce their own implementation plans to support delivery of the strategy.
Consultation is on-going, including with service users and carers, providers, district authorities and criminal justice colleagues, as well as with Clinical NHS colleagues for clinical oversight.
The strategy will pass through governance processes in the three Local Authorities and seven CCGs, with the intention it should be approved by Health and Wellbeing Boards in January. The intention is that it will be launched in February 2017.
4. Action required
The HOSC is invited to review and comment on the draft strategy documents, and the plans for development and implementation of the strategy. We would welcome feedback on the draft documents, both in general terms and on points of detail, both in the HOSC meeting and by e-mail or telephone. We would also welcome the opportunity to explore how we effectively disseminate, implement and monitor the strategy with HOSC.
Page 46 of 130 Given the timetable for agreeing the strategy, the deadline for feedback is 9 November. It would be helpful to receive any comments earlier if that was possible.
Please note that a copy of the full Strategy document is available on the website with the 9 November HOSC agenda papers.
Page 47 of 130
Page 48 of 130 DRAFT:Essex, Southend and Thurrock Mental Health and Wellbeing Strategy on a Sheet 2017-21 V Year on year reduction in premature mortality among people with OUR VISION o A single mental health commissioning severe and prolonged mental health issues. team to provide services for all ages
and across the whole County. V A focus on mental health and well-being in everything we do, o Mental health at the heart of all policy from healthy eating and physical activity to local planning. and services in Essex as we work with o Working in partnership and co- communities to build their resilience producing services with clinicians, V New and expectant mothers can access specialist support. and promote mental well-being for all. experts by experience, families and 21
- carers. V Transformation of services for children and young people. o Everyone needing support- including
families and carers - get the right o Drawing on best evidence and clinical V Better access to psychological therapies. service at the right time from the right practice, but not afraid to innovate 2020
people in the right way. and try new things. V A continued focus on older people and the links with dementia.
to o People get support at the earliest o Developing models of care that V More support with first episode of psychosis. opportunity, with support for ensure integrated, effective and recovery, promoting inclusion and accessible services for all. V All hospitals have mental health liaison teams, with at least half empowerment. working 24/7. o Focusing on prevention, early o Our services will be based on best intervention and supporting people V Home treatment and crisis support in the community, with more evidence and co-produced with people back into the community. people treated in their homes and less having to stay in hospital.
who use them. o Reducing costs through better V Reduction in suicide with the ambition of zero suicide. prevention and service models, and o There is a seamless ‘cradle to grave’ reinvesting that money in further approach recognising that mental V No-one in crisis held in a police cell for assessment. service improvements. health can be an issue throughout life.
V Offenders with mental health issues directed into treatment and o Being a voice for mental health on o People affected by mental health out of trouble at the earliest opportunity. the national stage and providing problems do not face stigma or
leadership . What we will deliver exclusion in Essex. V A year on year reduction in the employment gap between people in mental health services and others. o A resolute focus on delivering outcomes that matter to individuals, V More people supported out of mental health services and to live [Type text] HOW Page 49 of 130 families and communities. independently in appropriate accommodation.
The Essex Virtuous Circle
OUR CURRENT PRIORITIES • Reviewing all mental health funding to ensure best value for public money. • Bringing mental health trusts, GPs and primary care, public health, the voluntary sector and communities together to tackle mental distress and improve wellbeing. • Linking payments to providers to real improvements in mental health and wellbeing. • Improved use of co-production, data and information to drive service improvements.
Prevention & Early intervention Acute and Crisis Services Supporting recovery • Increasing access to psychological therapies from • Co-ordinating an integrated approach across Essex • Improving access to psychological therapies for 2017/18 to ensure at least 25% of people with informed by the Crisis Care Concordat. people with long-term physical conditions. depression/anxiety have access by 2020-21. • Redesigning the Approved Mental Health • Launching an Integrated Support, Advice, • Continue to increase peri-natal support. Professional Service to provide a 24/7 response. Recovery and Mentoring Service. • Ensuring that at least 40% of patients now • Developing liaison services in all our acute • Developing a new accommodation pathway to ending up in specialist services are getting the hospitals and working towards 24/7 standards. support people into independent living. right help in a primary care setting by 2020-21. • Eliminating out of area hospital placements. • Increasing employment, e.g., through Support and • Publishing a new Suicide Prevention Strategy. • Agreeing an implementation plan to ensure that Recovery Workers in therapeutic services. • Ensuring 50% of people with first episode of anyone assessed under the Mental Health Act is • Creating a service for Offenders with Complex psychosis get the right treatment within 2 weeks. managed in a suitable local facility. Needs and developing innovative services for • Improving diagnosis of Asperger’s and ADHD. • Expanding street triage forpeople in crisis. those with multiple need and personality disorder.
Page 50 of 130
Mental Health Strategy – Short Version Everybody in Essex is affected by mental health issues either directly or indirectly. One in four of us will experience a mental health problem each year, and we all have a stake in our own and others emotional wellbeing and resilience. Mental health is linked to every aspect of our lives, including physical health, the quality of our relationships, social inclusion and community safety. Failure to address mental health problems is not only bad for people, it is expensive for society too. The economic and social cost has been estimated at £105 billion annually in England, with the cost of dedicated mental health support estimated at £34 billion.
We have come together to develop a new strategy for Essex because we believe there is a unique opportunity to further promote good emotional wellbeing and mental health in our county, improve experience of mental health services and drive change . We are building on our experience of transforming our children and young people’s services, and the platform provided by a national focus on mental health transformation, with the publication of NHS England’s Five Year Forward View for Mental Health .
Our Vision for Mental Health
- We will put mental health at the heart of all policy and services in Essex as we work with communities to build their resilience and promote mental well-being for all. - We will ensure that everyone needing support in Essex – including families and carers – get the right service at the right time from the right people in the right way. - We will continue to remodel our services to ensure people get support at the earliest opportunity, with support for recovery, promoting inclusion and empowerment. - Our services will be based on best evidence and co-produced with people who use them. - We will develop a seamless ‘cradle to grave’ approach, recognising that mental health is an issue throughout life and there are heightened points of vulnerability. - We will play our part in challenging mental health stigma and promoting social inclusion and social justice for everyone affected by mental illness. - We will have a resolute focus on delivering outcomes that matter to individuals, families and communities.
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- We will have a resolute focus on delivering the outcomes that matter to individuals, families and communities, and will not let bureaucracy or silo-ed thinking get in the way.
Our principles
In delivering our Vision for Mental Health we will be guided by the eight principles set out in NHS England’s Five Year Forward View for Mental Health :
1. Decisions must be locally led. 2. Care must be based on the best available evidence. 3. Services must be designed in partnership with people who have mental health problems and with carers. 4. Inequalities must be reduced to ensure all needs are met across all ages. 5. Care must be integrated, spanning physical, mental and social needs. 6. Prevention and early intervention must be prioritised. 7. Care must be safe, effective and delivered in the least restrictive setting. 8. The right data must be collected and used to drive and evaluate progess.
Facing facts This strategy is informed by an assessment of mental health need in Essex which found:
- About 1 in 6 of our residents (150,000) are known to be living with mental illness, and there will be others we don’t know about yet. - As many as 1 in 5 new and expectant mothers will experience mental health problems in pregnancy or in the first 12 months after birth. - We estimate that 22,500 children and young people in Essex have a mental health problem requiring specialist help. - Around a third of people suffering from long-term physical health conditions have a mental health problem. - 25,000 older people in Essex have depression, and a further 8,000 experience severe depression. - We can expect around sixty thousand working age adults in Essex to experience two or more psychotic disorders. - The suicide rate in Essex increased between 2007 and 2014, despite a small reduction in the national rate, with Essex’s rate above national and regional averages. - It is estimated that between 15% and 25% of all police time in Essex is spent on incidents when mental health is a factor. - Complexity is common among individuals with mental illness in Essex, including links with learning difficulties, drug and alcohol misuse, offending and social exclusion. - Only half of adults in contact with specialist mental health services are in stable and appropriate accommodation.
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- The difference in the employment rate between people in contact with specialist mental health services and the general population was nearly 70% in Essex in 2013-14.
How will we do it?
We will realise our vision for mental health and well-being in Essex by:
- creating a single mental health commissioning team to provide services for all ages and across the whole county; - Working in partnership and co-producing services with clinicians, experts by experience, families and carers; - Drawing on up-to-date evidence and best clinical practice, but not being afraid to innovate and try new things; - Developing models of care that ensure integrated, effective and accessible services for all; - Focusing on prevention, early intervention and supporting people back into the community; - Reducing costs through better prevention and improved service models, and reinvesting that money in further service improvements; and - Being a voice for mental health on the national stage and providing leadership.
How will we pay for it?
Essex is experiencing increased demand for mental health services at a time when the NHS and local authorities have to make savings.
We have less money than we used to, and are likely to face further reductions in our budgets in the future. So, how will we pay for service transformation? We will ‘hold a mirror’ up to central government where necessary, and engage with Westminster and Whitehall to secure the support and resources that we need to deliver our vision and ambitions. But we believe that we can improve services and outcomes in Essex while saving money too … and then invest savings in further improvements, creating a virtuous circle.
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This approach follows NHS England’s Five Year Forward View for Mental Health , which concludes that an additional £1 billion will be needed in England by 2020-21, but that over time the national strategy can pay for itself, as improved service models and early intervention reduce the costs of picking up the pieces later on (figure 1). Taking this approach will require us to think imaginatively about how we use the resources that we have, and to work collaboratively to use them in the best way. It will also means fully mobilising the strengths and assets of people with mental health needs, families and communities.
Figure 1: Creating a virtuous circle
We will particularly target areas where there is unmet need and the potential for savings is significant. These include improving peri-natal mental health services for our new and expectant mothers and targeting the link between physical and mental health (for example by developing mental health liaison services to work in hospital emergency departments and smoking cessation interventions for people with mental health problems).
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Listening and learning
We have plenty to build on in Essex, and have already transformed our children and young people’s mental health services. We commissioned an independent review of our adult services, and have consulted with ‘experts by experience’, doctors, nurses and other clinicians working in mental health. There has been a striking congruence in their messages.
1. Simplify things. They all agreed that getting help for a mental health problem in Essex can be too complicated and confusing, including for people experiencing crisis. Part of the problem is the language that we use, with different organisations using different words for the same things and the same words for different things. 2. Better information. We need to collect more information and share it better. 3. Prevention is better than cure. Clinicians and experts by experience agreed on the need to improve continuity of care, with better support for people discharged from acute services, including with issues like debt, housing, jobs and relationships. Clinicians want mental health support to be embedded in GP surgeries and other primary care settings. 4. Choice and control . Experts by experience spoke of the benefits of being empowered to manage their own condition and said that this could be a vital component of recovery in its own right. Everyone agreed on the need to tackle stigma. 5. Mind the gaps . Our clinicians were concerned about a shortage of services, including access to psychological therapies and support for complex needs and personality disorders. They said people could fall down gaps, particularly when moving from young peoples’ to adult services and between primary care and specialist mental health care. 6. Training and workforce development . Experts by experience stressed the need for appropriate training fo r all professionals who work with people who experience mental health issues, from GPs to substance misuse, welfare advice and housing services. Clinicians are concerned about staff shortages in the mental health workforce and want more opportunities to share knowledge and information.
We believe we have made a first step to meeting these challenges by coming together to develop and deliver a joint strategy for the whole of Essex.
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Starting with the foundations
Public health activity is providing a firm foundation for well-being, resilience and good mental health. Support for children and young people is the bedrock for improved mental health and wellbeing across the life course. We have set out plans for the emotional wellbeing and mental health of children and young people in our Open up, Reach Out plan.
To ensure we get the foundations right, we will be guided by the principles of good commissioning practice set out in NHS England’s Five Year Forward View for Mental Health .
1. We will work in partnership with local stakeholders, including voluntary organisations. 2. We will ‘co-produce’ with clinicians, experts-by-experience and carers. 3. We will consider mental and physical health needs together. 4. We will plan for effective transitions between services, including between children and young people’s and adult services. 5. We will enable and support integration. 6. We will draw on the best evidence, quality standards and clinical guidance. 7. We will make use of financial incentives to drive improvements in service quality. 8. We will emphasise early intervention, choice, personalisation and recovery. 9. We will ensure all services are provided with humanity, dignity and respect.
We will work with criminal justice partners to support offenders with mental health problems to get well and recover, and reduce crime, recognising the high prevalence of mental health problems and the need to improve the co-ordination of custodial and community services. We will also engage with innovative approaches to the challenge of ‘multiple need’.
We recognise that we have some challenges in recruiting the professionals we need to deliver our vision, including specialist CAMHS commissioners, mental health nurses and social workers (including Approved Mental Health Professionals). NHS England’s Five Year Forward View for Mental Health includes a commitment to produce a national workforce strategy, and we will be engaging with government to make this happen.
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Doing things differently
We will invest in interventions and services that have been proven to work, while also exploring innovative new models of care, working collaboratively and creatively with people who use and provide services, and being prepared to learn from positive experiences in other localities. We will be guided by the three priority areas for innovation in NHS England’s Five Year Forward View for Mental Health :
- New models of care to deliver integrated and accessible services for all. - Expanding access to digital services, building in Essex on existing initiatives such as the Lifestyle Essex App, online Therapy for You service and on-line resources available through Mind and other voluntary sector services. - A system-wide focus on quality improvements. In particular, in Essex we will be working together to integrate services across the NHS and local authorities, and to improve links between young peoples and adults services, older peoples and mental health services, primary and specialist mental health services, physical and mental health support and NHS and voluntary and community sector organisations.
We have picked out three further areas to support innovation in Essex:
- Service providers should work with people who use services to ‘co-produce’ care pathways. - Service providers should make more use of their data to review and improve service delivery. - Service providers should work together to find ways of further supporting and developing our specialist mental health workforce, enabling them to deliver evidence- based interventions and making the very best use of existing resources. We are also committed to making as much information about our mental health system as possible available to the public, and will be assessing and measuring our performance by comparing outcomes with national averages and our statistical neighbours.
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What difference will we make? Our outcomes for 2020-21
1. Matters of principle 1.1 There will be a single mental health commissioning team for Essex bringing together local authorities, NHS and other partners around a common plan and shared priorities. 1.2 Parity of esteem will be fully established for all policy, strategy and practice in Essex 1.3 Experts by experience will be involved in shaping and designing strategy, policy and services, always and everywhere. 1.4 A year on year reduction in premature mortality among people with severe mental health problems through public health initiatives and integration with physical health. 1.5 Essex will build on its Zero Suicide work with a suicide prevention strategy from 2017.
2. Children and young people 2.1 Further transformation of emotional wellbeing and mental health services for children and young people with the implementation of our Open up, Reach Out prospectus. 2.2 The development of a single transition protocol between children and young people’s and adult services across Southend, Essex and Thurrock.
3. Older people 3.1 A renewed focus on improving mental health support for older people, recognising the need to support carers, and the impact of social isolation and loneliness. 3.2 Essex’s mental health and dementia strategies will be ‘joined up’ with better support for people with dementia who get depressed or anxious.
4. Common mental health problems 4.1 Improved access to psychological therapies for people with common mental health problems, with services integrated with physical health care and available in settings that are familiar to people and where they feel comfortable, such as GP surgeries. 4.2 People will access psychological therapies more quickly and at least half will recover.
5. Peri-natal mental health 5.1 All new and expectant mothers in Essex will have access to specialist mental health support.
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5.2 Health visitors in Essex will help to identify mothers who may be experiencing mental health problems and signpost them to support.
6. Acute and crisis support 6.1 At least 60 per cent of people in Essex experiencing a first episode of psychosis will start treatment with a specialist early intervention in psychosis service within two weeks. 6.2 All acute hospitals in Essex will have all-age mental health liaison teams in place, with at least half meeting the NHS ‘Core 24’ standard. 6.3 Expansion of home treatment and crisis support in the community, with more people treated in their homes and less having to stay in hospital. 6.4 No one in Essex who needs inpatient care will be placed in a hospital outside of Essex. 6.5 There will be more Approved Mental Health Professionals in Essex to make assessments under the Mental Health Act, with a new centralised services from 2017 operating 24/7.
7. Supporting people with complex needs 7.1 Liaison and diversion will be available in custodial settings across Essex, with street triage to divert individuals to treatment and away from trouble at the first opportunity. 7.2 Offenders with Complex and Additional Needs service in Essex, and other services for ‘multiple needs’ and personality disorder guided by emerging evidence and practice. 7.3 Elimination of the use of police cells as ‘places of safety’ for assessing people in crisis.
8. Life support for recovery 8.1 Everyone with a serious mental health and/or substance misuse problem will have the
opportunity to work with a peer mentor and to be trained to provide support for others. 8.2 More adults in contact with mental health services will access appropriate accommodation with a reduction of people living in mental health residential care, and
intensive support with issues like debt, finance advice and independent living. 8.3 More people will be supported into work through evidence based approaches with a year on year reduction in the gap in employment rates between working age adults in
contact with mental health services and the general population. 8.4 Year on year reductions in offending and reoffending by offenders with mental health
and related problems, such as personality disorder and drug and alcohol misuse.
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Page 60 of 130 AGENDA ITEM 13 HOSC/64/16
Committee Health Overview and Scrutiny Date 9 November 2016
Autism services in Essex
Report by: Graham Hughes, Scrutiny Officer Contact details: [email protected] Tel: 03301 34574
Action required
(i) To consider the issue referred from Full Council and the evidence provided by Health commissioners and providers; and (ii) To consider any further evidence required and actions to be taken by the Committee.
------
1. Background
At the July 2016 meeting of Full Council a question was raised about autism services in Essex and, as part of the Cabinet Member response, the Cabinet Member agreed to bring the issue to the Health Overview and Scrutiny Committee.
The text of the question and answer given at Full Council is reproduced overleaf.
Health commissioners and providers have been asked to respond to the questions reproduced on the third page of this report for inclusion in their advance paper for the HOSC agenda:
Attachments:
(i) South of Essex Commissioner’s Report (ii) Mid and West Essex Commissioner’s Report (iii) North East Essex Commissioner’s Report (iv) Provider report for North east, Mid and West Essex (v) Provider report for South Essex (vi) Commissioner report from Essex County Council (social care)
Page 61 of 130 2. Questions submitted to contributors
Providers are specifically asked to answer the following questions as part of their report (which as a guide should be a maximum of 6 pages).
Inconsistency of referral route
• Please provide details of referral route into NHS diagnostic service within your area ; if you could provide step by step information through the process from referral to discharge this would be helpful
Waiting lists
• How many people have been referred for an assessment but have yet to have their first appointment in your area as at the end of August 2016? • How many people have been referred and are currently in the process of receiving a diagnosis in your area as at the end of August 2016?
• Of the people who received a diagnosis as at the end of August 2016:
• Were referred out of area for diagnosis? • Did not meet Care Act eligibility criteria to access further support, even though they have received a diagnosis of autism?
• Please provide comparative reporting period to each of the questions above to demonstrate trend over two historical years previous to the date mentioned above.
Support offered • Can you confirm what the process is in your area if someone who has received a diagnosis of autism, does this automatically trigger an offer of a Care Assessment?
• In your area please confirm if reasonable adjustments have been promoted to enable people with autism to access NHS Services including primary care or GP Services, Mental Health and acute Services?
• How do NHS Crisis services in your area routinely anticipate and provide for the crisis needs of people with autism? Please provide information of any relevant pathway
Commissioners are also requested to provide a short report (suggest 2-4 pages) providing a commissioner overview of the issues above and any relevant strategic narrative around contract management and performance.
Page 62 of 130 3. Text of question at Full Council
ESSEX COUNTY COUNCIL MEETING 12 July 2016 Answers to Written Questions (standing order 16.12.1)
Agenda Item 13(a)
Extract
4. By Councillor Kendall of the Cabinet Member for Adults and Children ‘Autism is a major issue facing many families across Essex and a key concern for many of them is the consistency of diagnostic service for adults. I understand there are three different diagnostic services for different parts of the county because they are commissioned by separate CCGs and provided by different NHS Trusts. There currently seems to be an inconsistency of referral route, waiting lists, and support offered all based on where you live in the county. What steps is the Cabinet Member going to take to ensure a high quality consistent diagnostic service is made available to all residents in Essex regardless of where they may live?’
Reply ‘I note that the Statutory Guidance for Local Authorities and NHS organisations to support implementation of the Adult Autism Strategy (March 2015) states: ‘Clinical Commissioning Groups are expected to take the lead responsibility for commissioning of diagnostic services to identify people with autism, and work with local authorities to provide post-diagnostic support for people with autism (regardless of whether they have an accompanying learning disability, other hidden impairments or a co-occurring mental health problem).’ While lead responsibility for commissioning diagnostic services for adults rests with individual CCGs, ECC are working on common referral and diagnostic pathways in partnership with CCGs, those using the services, and service providers. Our approach is in line with the Essex Autism Strategy and our wider corporate outcomes. Data relating to diagnostic pathways are collected via the Department of Health self- assessment framework submission provided annually by ECC (as with other authorities in England and Wales) with the latest submission presented to the Health and Wellbeing Board on 23 July 2015 where the position was reported as follows:
Data relating to diagnostic pathways are collected via the Department of Health self- assessment framework submission provided annually by ECC (as with other authorities in England and Wales) with the latest submission presented to the Health and Wellbeing Board on 23 July 2015 where the position was reported as follows:
- North East Essex CCG has an adult ASD-3D (diagnosis, disclosure, and direction) service, fully integrated within its Health In Mind Improving Access to Psychological Therapies (IAPT) service. Referrals are accepted through GPs, and other agencies including Supporting Asperger Families in Essex (SAFE) and Autism Anglia. The current waiting time for ASD assessment is 10 months and this continues to reduce due to additional resources/increased assessments per week. - South Essex provides a service for Asperger's diagnosis, through GP referral, typically for adults aged between 18 and 30 years old. Currently, the waiting time Page 63 of 130 is over 2 years, but is expected to reduce over the next few months as SEPT will focus on reducing the waiting list. - Mid and West Essex Clinical Commissioning Groups (CCG) have an ASD Diagnostic Demonstration Project in place. Referrals are accepted through GPs for adults 18 years old, with or without an accompanying learning disability or mental health condition. The service also offers bespoke advocacy throughout the diagnostic pathway to individuals who require this additional support. Current waiting times to begin the assessment process range from 2 to 107 days, with an average of 45 days.’
15. Written questions to the Leader of the Council and Cabinet Members
The published answers to the 16 written questions submitted in accordance with Standing Order 16.12.1 were noted.
The following supplementary questions were asked as a result of having received a written reply:
(4) Councillor Kendall asked Councillor Madden, the Cabinet Member for Adults and Children, if (noting that the current wait for diagnosis of autism varied across the three CCGs from between two days and two years) he would welcome a review by the relevant Scrutiny Committee?
The Cabinet Member replied that he too was concerned about this matter and had asked the Adult Autism Commissioning Group to engage with the Council and the Clinical Commissioning Groups to investigate a new approach which he intended to present to the Health Overview and Scrutiny Committee by the end of the year.
Page 64 of 130 ASPERGERS SERVICE REVIEW
Essex Health Overview and Scrutiny Committee
November 9 th 2016
Introduction
Autism spectrum disorder (ASD) is a condition that affects social interaction, communication, interests and behaviour. It includes Asperger syndrome and childhood autism. Some people also use the term autism spectrum condition or ‘neurodiverse’ (as opposed to people without autism being ‘neurotypical’). The main features of ASD typically start to develop in childhood, although the impact of these may not be apparent until there is a significant change in the person’s life. In the UK, it's estimated that about one in every 100 people has ASD.
The Autism Act 2009 was the first legislation designed to address the needs of Adults on the Autism Spectrum and placed a duty on the Secretary of State to prepare and publish an Autism Strategy for improving the provision of relevant services to meet the needs of people with Autism. It also required the Secretary of State to issue Guidance to NHS Bodies, Local Authorities and the Foundation Trusts
“Fulfilling and Rewarding Lives – Strategy for Adults with Autism in England” was published by the Department of Health in March 2010. This was followed by Implementing “Fulfilling and Rewarding Lives”, Statutory Guidance for NHS Organisations and Local Authorities to Support the Implementation of the Autism Strategy” in December of the same year. The Autism Act (2009), the Fulfilling and rewarding lives: the strategy for adults with autism in England (DoH2010) as well as The National Institute for Health and Clinical Excellence (NICE) guideline covering recognition, referral, diagnosis and management of autism for adults (June 2012). These documents highlight the importance of local service pathways for diagnosis as well as support and detail what NHS services and local authorities should be providing to meet the needs of individuals with an autism spectrum disorder and their families.
Think Autism Update was published in April 2014 to reaffirm the importance of the 5 areas for action identified in the Autism Strategy namely:
1. increasing awareness and understanding of autism
2. developing clear, consistent pathways for the diagnosis of autism
3. improving access for adults with autism to services and support
4. helping adults with autism into work
Page 65 of 130 5. enabling local partners to develop relevant services
BACKGROUND
The SEPT Asperger’s service is commissioned by the four South Essex CCGs (Basildon& Brentwood CCG, Southend CCG, Thurrock CCG, Castlepoint & Rochford CCG) to deliver and provide diagnostic assessment and intervention service for young people (18-30 years), and assessment for those over 30 years of age to assist in establishing a differential diagnosis. This service is currently delivered via a South Essex footprint though based in Basildon at the Community Resource Centre. The referral route is directly through a consultant psychiatrist or the local First Response Teams in conjunction with psychiatry to ensure that a full history on the individual being referred and that any mental health problems can be excluded or addressed prior to the referral being made. The Service currently offers provision on a two tier level providing assessment; and where a diagnosis of Asperger’s Syndrome is made or where individuals who already have an existing diagnosis can be referred to. Both groups can then access a range of support including vocational support, occupational therapy, family therapy and individual psychology services. People over the age of 30 will be offered an assessment and access to the groups run by the service. Assessment is generally time limited, but in line with best practice, is a lengthy process.
Appertaining Issues
The number of referrals has been increasing year on year. Over the past two years there have been a higher number of referrals to the service which outweighs the team’s capacity thus creating and culminating to an unmanageable waiting list with access to service for individuals longer than the recommended guidance. NICE guidance recommends a timescale for assessment from referral to be nothing more than three months. A review of the service by CCGs concluded a heightened risk with individuals having to wait as long as over 53 weeks for an assessment which is not in accordance with the NICE guidelines. The National Institute for Health and Clinical Excellence (NICE) guideline covering recognition, referral, diagnosis and management of autism for adults released in June 2012, provides guidance with clarity to both Heath & Social Care covering every aspect of care for people with autism across the spectrum. Key recommendations include:
• Specialist autism teams, such as the Liverpool Asperger Team and Bristol Autism Spectrum Service, should be established in every area and equipped with the knowledge to offer diagnosis, training and support. The team in South Essex fulfils this requirement but is limited in its capacity
• Local multi-agency groups should be set up, with representation from a range of service areas, to take the lead on changing services locally
• Improved support for adults with autism who are experiencing mental health problems
Page 66 of 130 • Adults with autism, and where applicable their families and carers, should be more involved in the development of their own support plans
Demand Management & Service development:
Following the review of the service additional funding was provided by the South Essex CCGs to ensure the service was more robust in managing capacity and thus address the assessment needs by allowing it to more closely match the demand. As part of the funding and in ensuring management of waiting list there are requirement for the trust to develop an action plan against this requirement. Also as a requirement and currently being undertaken are the following:
• SEPT to work with Commissioners to undertake a full review of service specification including pathways, and outcomes. • Working with SEPT and clinical lead to identify and agree necessary service changes. Implementation plan will be developed with clear prioritisation for scheduled development. And contract management
• Revised Specification and KPIs and reporting requirements to be agreed.
• Commissioner requirements are clearly outlined and formally agreed within the Service Specification.
Prepared by:
Alfred Bandakpara-Taylor Senior MH & LD Commissioning Manager BBCCG
Page 67 of 130
Page 68 of 130 WECCG and MECCG HOSC BRIEFING 9 November
ASD HOSC BRIEFING WEST AND MID ESSEX CCGS The national drivers for developing Autism services derive from the Autism Act 2009 and the Autism Strategy ‘Fulfilling and Rewarding Lives’ (DH 2010). These require NHS bodies to provide diagnostic services for those suffering from Autistic Spectrum Conditions by 2012. Commissioners are required specifically to develop NICE-compliant diagnostic and care pathways.
Essex County Council has taken the lead in partnership with CCG colleagues in writing and delivering the local Autism Strategy, which is a key requirement of local authorities in the Autism Act. There are five areas for action aimed at improving the lives of adults with autism:
• increasing awareness and understanding of autism; • developing a clear, consistent pathway for diagnosis of autism; • improving access for adults with autism to services and support; • helping adults with autism into work; and • enabling local partners to develop relevant services.
The Strategy is not just about putting in place specialist diagnostic autism services but more about enabling equal access to mainstream services. What this means in practice is providing support and opportunities through reasonable adjustments, training and the general raising of awareness
The Local Picture
Progress on the implementation of strategies has been monitored nationally through the Autism Self-Assessments. The 2nd Autism Self-Assessment (ASA) was submitted to the Health and Wellbeing Board for endorsement in January 2014. Healthwatch Essex advised that there was a lack of a coordinated approach across Essex and that the adequacy of diagnostic pathways was questioned. The service commissioned last year was able to address this and was reflected in the 3rd Self -Assessment return in January 2015. The statutory responsibility for the commissioning of the diagnostic component of the Autism strategy lies with CCGs. What we commission
In April 2014 we commissioned a service across the NHS Mid and West Essex geographical areas from Hertfordshire Partnership NHS Foundation Trust (HPFT). The contract for the service runs until 30 September 2015. This has been extended to March 17 with a view to further extending the service offer to meet the requirements of the Autism Act 2009.
The service provides a single point of entry for referral to a specialist team who will confirm or not a diagnosis of autistic spectrum disorder in line with the World Health Organisation ICD-10 and DSM 1V guidance also taking into account the proposed changes e in DSM V guidance, published in 2013 . It is available within working hours (9 am – 5 pm) and offers equitable access to all persons from age 18 years including all people, with or without a co-morbid learning disability or mental health condition.
The key features of the service that will ensure it is fully compliant with statute, local Autism Strategy and NICE guidance include: - Page 69 of 130 1 | P a g e
WECCG and MECCG HOSC BRIEFING 9 November
a local specialist diagnosis of autistic spectrum disorders; a multi professional functional assessment and critically support immediately following diagnosis; access to an assessment of need from Essex Social Care under the NHS & Community Care Act 1990 and Essex County Council’s Fair Access to Care criteria in relation to community services where a diagnosis of autism has been confirmed; An innovative “Navigator” scheme run by the local voluntary sector to provide advocacy and practical support to ensure access to a range of services following assessment this provides support that has enabled positive outcomes around maintaining employment, 71% of Clients Signposted to other services, ensuring reasonable adjustments are made to enable access to education.
This is not solely a ‘diagnostic’ service but offers dedicated support and guidance post-diagnosis. The service will carry out the more important function as far as the DH and NICE are concerned of getting people back into ‘mainstream’ life by teaching a range of life management skills which ensures that they can manage the condition and do not become life-long patients. This is arguably the most significant part of the pathway because although Fair Access to Care entitles people with a diagnosis of ASD to assistance, in reality the bar is set very high and only the most complex people will meet the criteria meaning some 90% of people will not.
What is the potential demand for the service?
Population aged 18-64 predicted to have Autistic Spectrum Disorders (source: PANSI November 2014)1
West Essex Total target ASD population 2014 2020 2030 Uttlesford 481 497 530 Harlow 501 518 542 Epping 784 805 865 West Essex Total 1727 1820 1937
Mid Essex Total target ASD population 2014 2020 2030 Braintree 885 898 910 Chelmsford 1029 1043 1056 Maldon 356 354 342 Mid Essex Total 2270 2295 2308 Total Mid & West 3997 4115 4245
The service will include within the cohort; (i) service users needing a full clinical diagnostic work-up and Navigator support post- diagnosis and (ii) Service users on a “fast track” i.e. people already in receipt of earlier clinical diagnosis that now require the timely support of therapists and Navigators to assist them to be
1 The prevalence rates have been applied to ONS population projections of the 18 to 64 population to give estimated numbers predicted to have autistic spectrum disorder to 2030. ( PANSI 2014)
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independent and re-integrated into work and communities.
It is of note that beyond this period of time the intent was to incorporate this service into the LD Procurement process. The intention is therefore for a joint procurement of LD and ASD services, with a service commencement date of 1 October 2016. However, given a shift in LD Procurement timescales this is no longer an option
Agreed service/ entry criteria specification: • Referral by GP via the Exceptional Cases Panel. • Referral accompanied by: - • Completed AQ10 form scoring above 6 (for person without intellectual disability) OR completed LD Screening Tool (for person with intellectual disability); AND • Letter from the GP explaining why they think that ASD assessment is appropriate. • Referred person is not currently open to Mental Health or Learning Disability services or in crisis that would require the services of either of these teams. • All incoming referrals are screened by Clinical Psychologist to check suitability. Waiting lists NB/The Service has a triage protocol function outlined below to support timely prioritised access for those people requiring diagnosis
Protocol for screening once the referral has been received: - • Referral information is screened by Clinical Psychologist for suitability on receipt. • When the person comes off the Waiting List they are sent a Biographical Questionnaire and Consent Form to complete. When returned, this is reviewed by an Assistant Psychologist with support as needed from a Clinical Psychologist to screen e.g. for current risk such as suicidality, other issues that might suggest that the referral needs to be prioritised or sent elsewhere and for overall suitability. • The person is then visited by an Independent Advocate who meets with them and an informant to complete further screening questionnaires (AQ, EQ and RQ; Sensory Questionnaires). On receipt of these from the Independent Advocate, the scores are reviewed by an Assistant Psychologist, with support as needed from a Clinical Psychologist, to check that they are in the range indicative of possible ASD. If not, this is discussed with the Independent Advocate and the referral information is reviewed again for suitability. • With the person’s consent, their GP is asked to provide copies of all information that might be pertinent to an assessment e.g. letters, reports etc. This is reviewed by an Assistant Psychologist with support as needed from a Clinical Psychologist to check for any issues pertinent to screening or to the assessment. • The Independent Advocates also let us know if any reasonable adjustments are needed for the assessment appointment.
Triage prioritisation protocol • Referrals are seen in the order in which they are received unless we are notified of or pick up in the incoming information any reasons for prioritising them. • Examples of issues that have led to prioritisation have included: - • Issues of risk; Page 71 of 130 3 | P a g e
WECCG and MECCG HOSC BRIEFING 9 November
• Person in danger of losing job and needing reasonable adjustments/ support; • Person about to begin university and needing reasonable adjustments/support
• How many people have been referred for an assessment but have yet to have their first appointment in your area as at the end of October 2016? - Please see Appendix 1 • How many people have been referred and are currently in the process of receiving a diagnosis in your area as at the end of October 2016? - Please see Appendix 1 • As at end September 2016 - all Open Cases are engaged with the service
• Of the people who received a diagnosis as at the end of August 2016: • Were referred out of area for diagnosis? - None • Did not meet Care Act eligibility criteria to access further support, even though they have received a diagnosis of autism? – Not known at this time Waiting Times In the 12 months to March 16 average waits:
West: 22 weeks North: 41 weeks South: 72 weeks Mid: 23 weeks
Taken from the ASD self-assessment recently submitted (based on information from the provider).
Support offered •Can you confirm what the process is in your area if someone who has received a diagnosis of autism; does this automatically trigger an offer of a Care Assessment? Yes – all clients with diagnosis of Autism are supported in accessing a Community Care Assessment from ECC via the support/advocacy element of the pathway in West and Mid Essex. This is provided by Tendring Mental Health Services (TMHS)
•In your area please confirm if reasonable adjustments have been promoted to enable people with autism to access NHS Services including primary care or GP Services, Mental Health and acute Services? - WECCG have actively promoted this through the Learning Disability Stakeholder Board. This has also been promoted in West and Mid through the Advocacy/support/advocacy element of the Reasonable adjustment and Equality Delivery System are embedded in all NHS standard service contracts.
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Table 1: Activity volume for the Mid and West Essex Adult ASD Service as at 27.10.2016
West Essex Mid Essex Places commissioned for 24+6 months ( Places taken) 80 80(64+16) Have had full assessment or scheduled to receive one 36 61 On pathway (i.e. initial questionnaire or referral sent to 04 05 Advocacy) but not yet scheduled for appointment Total places taken 40 66 Waiting list – to be taken off when space available 14 14 Received and logged but not acknowledged - paused 0 07 Refused or declined assessment before first appointment 4 (11) Total referrals 54 87
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Page 74 of 130 North East Essex CCG Autism Spectrum Disorder 3-D (Diagnosis, Disclosure & Direction) Service
In January 2012 North East Essex CCG funded a 12 month local ASD 3-D pilot. In 2014 this pilot was integrated as a fully funded component of the North East Essex Health In Mind IAPT service.
The aims of the ASD 3-D service are: • To provide a diagnostic screening and assessment service for adults who have not previously been assessed for ASD, are not in further/higher education and do not have a co-morbid mental illness or learning disability. • To offer a Disclosure Interview to the individual and their significant others, to socialise them to the diagnosis and provide psycho-educational material. • To provide a brief (12 week) solution focussed intervention with STaR worker support. • To facilitate timely and relevant signposting to appropriate local services. • To avoid the risk of deterioration of the mental health of the client/carer through lack of timely intervention and support. • To offer the solution focussed and signposting service to local clients who have received an out of area diagnosis with no local follow up. • To provide autism awareness training to relevant staff/stakeholders.
The ASD 3-D service provides: • a neurodevelopmental diagnostic assessment • a written report and face to face disclosure • full information and face to face support with the individuals family or carer • followed by a 6 session of direction and support community programme.
2016/17 Activity: Table 1. The number of referrals received each month and interventions delivered each month
April May Jun Q1 Jul Aug Sep Q2 Total Total Referrals received 8 6 10 24 5 6 6 17 No. onward signposting 0 0 1 1 0 1 2 3 Initial questionnaires sent out 9 6 2 17 Initial questionnaires returned 6 23 10 39 11 1 7 19 Stage 1 AAA documents 3 11 1 15 7 0 4 11 completed Stage 2 AAA assessments 6 8 9 23 10 4 7 21 Disclosures 8 5 11 24 9 1 12 22 No. diagnosed 4 5 10 19 8 1 12 21
Table 2. Total number of open cases and the number of patients at each stage of the care pathway.
April May Jun Jul Aug Sep Total no. open cases 67 68 65 57 60 52 No. to return initial 10 questionnaires No. awaiting Stage 1 AAA 27 29 22 assessment No awaiting Stage 2 AAA 5 1 12 assessment No. awaiting disclosure 8 11 6 No. open to follow up 2
Table 2 shows the total number of open cases in each month, and the number of patients in each stage. These are running totals (month on month), with the current position being the figures presented for September. The number of open cases (52) has been falling since November 2015 (81) as a consequence of increased stage 2 assessments being offered relative to the numberPage of 75 referrals of 130 received.
All 52 Open Cases are engaged with the service.
Inconsistency of referral route
• Please provide details of referral route into NHS diagnostic service within your area ; if you could provide step by step information through the process from referral to discharge this would be helpful
Clients can be referred directly to the NEE ASD 3-D service from:
• GPs • JobCentre Plus • Autism Anglia • SAFE • Swan Floating Support • MIND • NEPFT
Exclusions: • Not previously had a diagnostic assessment • Have an IQ of 70 or above • Do not have an acquired brain injury • Do not have a substance misuse problem • Do not have a co-morbid Learning Difficulty or Serious MH condition
Diagnosis: • STaR Worker support to complete questionnaires and prepare for assessment process • One day intensive assessment appointment using Autism Diagnostic Observation Schedule (ADOS) and other validated assessment tools • Psychometric testing with client • Developmental history taking with family
Disclosure • Feedback from assessment • Psycho-education to client and family as appropriate • Introduction to STaR Worker (support worker)
Direction • ADL support and introduction to accessing solution focussed resources/brief interventions • Signposting as appropriate • Time limited STaR Worker support.B
Waiting lists
• How many people have been referred for an assessment but have yet to have their first appointment in your area as at the end of August 2016? - Please see tables 1 & 2 above • How many people have been referred and are currently in the process of receiving a diagnosis in your area as at the end of August 2016? - Please see tables 1 & 2 above
As at end September 2016 - all 52 Open Cases are engaged with the service
• Of the people who received a diagnosis as at the end of August 2016: • Were referred out of area for diagnosis? - None • Did not meet Care Act eligibility criteria to access further support, even though they have received a diagnosis of autism? – Not known at this time
Support offered • Can you confirm what the process is Pagein your area76 of if someone130 who has received a diagnosis of autism, does this automatically trigger an offer of a Care Assessment? Yes – all clients with diagnosis of Autism are supported in accessing a Community Care Assessment from ECC
• In your area please confirm if reasonable adjustments have been promoted to enable people with autism to access NHS Services including primary care or GP Services, Mental Health and acute Services ? - Reasonable adjustment and Equality Delivery System are embedded in all NHS standard service contracts.
Author:
Paul Rogers
Mental Health Commissioning Manager – Primary Care services : North Essex North East Essex CCG Aspen House Severalls Business Park Colchester Essex CO4 9QR
Phone: 01206 918663 Mobile: 07891302240 Email: [email protected] CCG Email: [email protected]
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Page 78 of 130 Mid and West Essex ASD Diagnostic Service
Information for Scrutiny Committee October 2016
Inconsistency of referral route
Please provide details of referral route into NHS diagnostic service within your area; if you could provide step by step information through the process from referral to discharge, this would be helpful
Mid and West Essex ASD Diagnostic Service
Information about the Service and how to make a referral was supplied to GPs by the CCGs. The Service accepts referrals from adults who are not open to secondary services in Mental Health or Learning Disabilities. To make a referral, the GP is required to write a short letter explaining why an ASD assessment is required and to send it to the Exceptional Cases Panel, together with EITHER a completed Form AQ10, which is the NICE recommended screening tool for people who do not have a learning disability, scoring at least 7 (or, if they do not, explaining why they should nevertheless be assessed for ASD); OR a Screening Tool compiled in-house by the Service, based on NICE recommendations for people who have a learning disability. Once the referral is accepted, letters are sent to the Service User and their GP to let them know that they are on a waiting list and our contact details. When they come to the top of the Waiting List, a letter is sent to the Service User enclosing a Consent Form for carrying out the assessment, for sharing information with the Independent Advocates, for speaking to significant others (many people with ASD are not confident to speak to us themselves) and for requesting information from other professionals. A Biographical Questionnaire is also enclosed to begin to gather initial information about the person’s living situation and past and current support. It is explained that, once these things have been returned to us, an Independent Advocate will make contact with the Service User to begin the assessment. Once the Consent Form and Biographical Questionnaire have been received back (assuming relevant consents are given), they are forwarded to the Independent Advocates, who contact the Service User direct to make a time to meet with them and a family member or friend at a place and time of their choosing. The Advocate then supports the Service User to complete the Autism Quotient (AQ) and Cambridge Behaviour Scale (EQ) Questionnaires and a sensory questionnaire and their relative or friend completes the Relatives’ Questionnaire (RQ) and a sensory questionnaire. The questionnaires are returned to the team for review, together with any information that the Advocate considers relevant eg how easily the person was able to complete the questionnaires or about the need for any reasonable adjustments on the assessment day. The AQ, EQ and RQ are reviewed by clinicians and, if they are indicative of a possible ASD, an assessment date is offered (so far, no-one has been screened out at this stage). A letter is sent to the Service User, explaining exactly what will happen on the Assessment Day and including the names of the clinicians who they will meet. They are asked to bring an informant, preferably someone who has known them since childhood.
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On the Assessment Day, the assessment process is explained and the Service User is asked for consent to proceed. They are invited to ask questions at any time throughout the day and also to request breaks as needed. Background information is gathered to clarify the reasons for the referral and the Service User’s hopes for the outcome. A clinical interview is undertaken using the Adult Asperger Assessment (AAA). The assessment day includes a shared sandwich lunch, so that there is an opportunity for informal social talk. If needed, additional information is gathered using the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R) and sometimes other tools such as the Mind in the Eyes Test or Test of Social Inference and Reasoning (TASIT). It is explained at the outset that a diagnosis will not be given on the Assessment Day because every case is discussed with the multi-disciplinary team (MDT). The information gathered is discussed at the monthly MDT meeting with a view to reaching a diagnosis, following which a Report is written and a Feedback session booked. The Service User is given the option of inviting the Independent Advocate and/ or a family member or friend to the Feedback session. At the Feedback session, the clinician reads through the Report with the Service User in order to check that it is accurate and that they understand and are happy with what has been said. It is then signed and a copy is sent to anyone for whom permission is given to share – usually including the GP. If a diagnosis is given, the Report includes information about ASD and how it is assessed; explains how the diagnosis was reached; offers some individualised suggestions where appropriate and, in every case, includes some generic suggestions relevant to ASD. Relevant factsheets from the NAS may also be provided. If a diagnosis is not given, a shorter report is written which explains the reasons why not and in most cases includes some suggestions for what next. Following Feedback, whether or not a diagnosis has been given, the Independent Advocates are able to offer the Service User time-limited signposting and support.
North East Essex IAPT ASD Diagnostic Service – will provide their data separately
1. Waiting Lists
How many people have been referred for an assessment but have yet to have their first appointment in your area as at the end of August 2016
Mid and West Essex ASD Service
As at end August, there were 31 people who had yet to have their first appointment. Of those, 24 were on the Waiting List and 05 had either been offered a time to meet with an Advocate or had not responded to contact. In addition, a further 12 people had been referred but the referrals had not been progressed because meetings were underway with commissioners regarding the future funding of the service.
North East Essex IAPT ASD Service – will provide their data separately
How many people have been referred and are currently in the process of receiving a diagnosis in your area as at the end of August 2016?
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Mid and West Essex
As at the end of August, 13 people were in the process of receiving a diagnosis (ie had been assessed and were awaiting feedback or were booked in for assessment). Over the period from start September 2015 – end August 2016 – o 46 people received feedback following a full assessment (this does not take account of people who did not proceed to a full assessment (eg because they did not respond or did not wish to proceed); and o 76 people were referred for assessment
North East Essex IAPT ASD Service – will provide their data separately
Of the people who received a diagnosis as at the end of August 2016 (a) How many were referred out of area for diagnosis; and (b) how many did not meet Care Act eligibility criteria to access further support, even though they have received a diagnosis of autism?
(a) Of those referred to our service, none was sent out of area for diagnosis. (b) Information from the Independent Advocates and STaR workers working in HPFT regarding Care Act eligibility is as follows: -
Comments about Care Act Eligibility: -
Care Act criteria state that adults are eligible for an assessment if: -
• Their needs are caused by physical or mental impairment or illness: ASD would count as such; AND • As a result they are unable to achieve two or more specified outcomes: a very high number of people with ASD would meet at least two of the following three outcomes: -
1. Developing and maintaining family and other personal relationships
2. Accessing and engaging in work, training or education or volunteering
3. Making use of necessary facilities in the local community including public transport and recreational services and facilities.
As a result, most people who are assessed for ASD would meet the criteria for an assessment under the Care Act.
In addition, in the light of the high levels of ongoing support that they offer, a significant number of family members are eligible under the Care Act for a Carer’s Assessment. The following information is taken from a sample of 13 clients who are currently open to the Independent Advocates in Mid and West Essex (not all necessarily received their diagnosis in the time period specified but the sample is believed to be representative and is also in line with Department of Health figures): -
• 8 qualified for a needs assessment under the Care Act
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• 5 declined this option, as they felt it would be detrimental to their future opportunities in employment or existing employment and would marginalise them. • 3 are eligible for care and support services.
Comments about need for specific support/ access to assessments for support/ timely support: -
Many people with ASD struggle to get appropriate, ASD-specific support in a range of areas including: access to their benefits entitlement; support to obtain reasonable adjustments in the workplace; access to appropriate support to meet their Mental Health and Physical Health needs; appropriate housing; meaningful occupation. Families supporting people with ASD also struggle to access appropriate information and support.
Observations from North Essex were that the issue is not one of eligibility (see above) so much as the availability of appropriate support, with Adult Social Care accepting that there are needs but it proving hard to find the support that the person actually wants or needs (eg an individual who wanted an apprenticeship or help to find work was offered funding to get involved in sport).
Long waits for assessment were also noted. Many people on the Autism Spectrum find the uncertainty of waiting particularly difficult, to the point that it can have a very material impact on their wellbeing. This, coupled with the limited availability of ASD-specific support at the end of the process, means that professionals may judge that the possible gains of a referral to Adult Social Care are outweighed by the limitations of what can be offered. And, as noted in the figures above, some people with ASD may decline assessment because some aspect of the way in which this support is offered is viewed by them as potentially detrimental.
We would suggest that careful thought needs to be given to how best the care needs of people with ASD can be met, so that support is accessible, timely and ASD-specific.
Numbers referred in Mid & West Essex:
83 referrals to Advocacy were received during that period. 29 that had a needs assessment and of that 29 , 10 were eligible for support services and 19 were signposted to universal service i.e. floating support and IAG.-
Please provide comparative reporting period to each of the questions above to demonstrate trend over two historical years previous to the date mentioned above
Mid and West Essex
In the years 2013 – 2014, HPFT were awarded CQUIN funding to design an ASD diagnostic pathway for 20 cases only. Data from this period is, therefore, of limited value in demonstrating a historical trend, because the numbers were capped. From October 2014 – October 2015, HPFT were asked to continue the Pathway in a Test to Progress phase. Over this period, [74] referrals were made to the service, of which [34] were completed by the end. A further [11] did not proceed to full assessment.
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2. Support Offered (a) Can you confirm what the process is in your area if someone who has received a diagnosis of autism, does this automatically trigger an offer of a Care Assessment?
As we are an NHS Trust, we are not in a position to offer a Care Assessment. However, the Independent Advocates working in our service do support people to apply for a Care Assessment, if they choose to do so. See information above.
(b) In your area please confirm if reasonable adjustments have been promoted to enable people with autism to access NHS Services including primary care or GP Services, Mental Health and acute Services?
As part of our assessment process, the Independent Advocates with whom we work let us know if any reasonable adjustments are needed for the people who are coming to us for an assessment.
Learning Disabilities Services within HPFT would look at reasonable adjustments on a case by case basis in order to enable people with autism to access services.
North East Essex IAPT ASD service within HPFT – will provide their data separately
We do not have control over whether other NHS Services, including Primary Care and GP Services. Mental Health and Acute Services are able to offer reasonable adjustments, because all these services are located in different NHS Trusts. However, we do highlight relevant issues in our diagnostic Reports and, where necessary, the Independent Advocates with whom we work would be able to support the person to request these from the services that are listed, as well as in other relevant settings, such as at work.
(c) How do NHS Crisis services in your area routinely anticipate and provide for the crisis needs of people with autism? Please provide information of any relevant pathway.
Learning Disabilities Services within HPFT include an Intensive Support team who could support anyone with autism and a Learning Disability who was in need of crisis support. In order to access anticipatory support, a referral would need to be made to the Learning Disabilities Team. If the person with autism was at that time eligible for their services and needed this support, a referral would be made after the diagnostic assessment.
Mental Health Crisis teams are located in another NHS Trust and, as such, we do not have information about their pathways.
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Page 84 of 130 South Essex Aspergers Service
The South Essex Aspergers Service was first commissioned in September 2009. Although at this point in time no capacity was set, since this time we have worked closely with commissioners to establish the demand for the service and to increase resources. Unlike in some other commissioning areas, our commissioners have made the decision to provide a wrapped care approach which offers intervention and support in addition to diagnostic assessments. Once an assessment has been completed therefore there is continued work and involvement from the services.
The service is provided across the whole of the South Essex area and its original staffing was 0.4 wte of a clinical psychologist (responsible for diagnostic assessments), 0.43 wte of an OT and 1 wte assistant psychologist. This staffing ratio provided capacity to assess and support 17-23 people a year when the demand was at least twice that. The impact of this inconsistency between capacity and demand was that the waiting time for assessments continued to increase. To address the increased demand the commissioners made the decision to increase resources for the service in order to reduce the waiting time. We have assessment appointments booked until the end of February 2017 which means that the waiting list currently stands at 75.
Inconsistency of referral route
• Please provide details of referral route into NHS diagnostic service within your area; if you could provide step by step information through the process from referral to discharge this would be helpful.
Referral route in:- Our service accepts referrals for individuals who are seeking a diagnostic assessment as well as those individuals who have an existing diagnosis of an Autism Spectrum Condition or Disorder and may need support.
The referral route into the South Essex Aspergers Service is directly through a consultant psychiatrist {Adult Mental Health (AMH) or Child and Adolescent Mental Health Services (CAMHS but now known as EWMHS)} or the First Response (FRT) and Recovery and Wellbeing (RWB) teams (previously known as the Community Mental Health Team). These referral routes are to ensure that the Service receives a full history on the individual being referred and that any mental health problems can be excluded or addressed prior to the referral being made.
Individuals that are not currently known to mental health services will be referred by their GP to the FRT or to a Consultant Psychiatrist and then following an assessment will be referred on to the Aspergers Service if there are concerns around an Autism Spectrum Condition or Disorder (ASC/ASD).
Once an assessment (either diagnostic, screening or post diagnostic) is completed a plan of care is discussed with individuals and their families where appropriate. This plan of care takes into consideration what mainstream services are available and
Page 85 of 130 whether these will be accessible for the individual either in place of or in conjunction with support from the service directly.
Our service provides both 1-1 and group support. In terms of groups we provide an anxiety management group which uses CBT principles and has been developed specifically for individuals with an Autism Spectrum Condition or Disorder (ASC/ASD). This is a new group and we have also looked at the possibility of providing it on a 1-1 basis if it is not possible for an individual to take part on a group basis. We also offer a social skills group which is based around the National Autistic Society (NAS) Socialeyes programme. Again this is offered on a group basis but it is also possible for it to be used on a 1-1 basis with individuals who find it difficult to attend a group. These are ‘psychoeducation’ groups however we also offer group work which aims to provide a focus for social skills work in a more natural setting to minimise problems with transferring skills acquired.
The additional groups currently being offered consist of: a weekly ‘confidence in running group’ (includes general fitness and running skills, activities are team, pair and individual), a weekly ‘confidence in sports group’ (includes team sports based activities as well as general fitness) and a monthly reading group (as in a mainstream reading group a book is chosen to read and discuss but the discussions extend to wider subjects including relationships and need to take into account the other members of the group). All these groups are attended by members of the service and work continues on an individual basis outside these sessions. As well as providing social networks these groups provide a framework to enhance individuals’ understanding of social interaction, communication, turn-taking, problem solving, decision making and respect for others. The sports related groups are run in conjunction with the local sporting village enhancing partnership working and accessing mainstream public services.
The 1-1 work for individuals may be utilising the social skills or anxiety work adapted from the group approaches. It can also be around accessing the community, support with employment or education, work around sensory sensitivities and activities of daily living.
In conjunction with an individual we will identify what areas they feel they require support in and offer this either through the service directly or if appropriate make a referral onto another service such as for example the employment specialist or AMH psychology for this piece of work. Within our service once the work is complete or once referrals have been made onto other services an individual will be discharged. They can be in contact with our service again either through a re-referral or contacting the service directly if it is less than 4 months since their discharge. There are individuals whose only contact with our service is around a diagnostic assessment and they do not require anything further beyond this so will be discharged once the assessment is complete.
Waiting lists
• How many people have been referred for an assessment but have yet to have their first appointment in your area as at the end of August 2016?
Page 86 of 130 As at end of March 2015 there were 93 people awaiting a diagnostic assessment with the service in South Essex.
As at the end of August 2016, there were 118 people awaiting a diagnostic assessment with the service in South Essex.
• How many people have been referred and are currently in the process of receiving a diagnosis in your area as at the end of August 2016?
63 Referrals received from 1 st April 2013 – 31 st March 2014 60 Referrals received from 1 st April 2014 – 31 st March 2015 54 Referrals received from 1 st April 2015 – 31 st March 2016 21 Referrals received from 1 st April 2016 – 9th Sept 2016
30 Diagnostic assessments completed 1 st April 2013 – 31 st March 2014 28 Diagnostic assessments completed 1 st April 2014 – 31 st March 2015 23 Diagnostic assessments completed 1 st April 2015 – 31 st March 2016 21 Diagnostic assessments completed 1 st April 2016 – 9th Sept 2016
The additional resource for the service to address the waiting list was implemented on the 8 th August 2016 and this accounts for the increase in diagnostic assessments in recent months. Prior to this there had been a period of time (1 st November 2015 – 1st July 2016) when there had been additional limitations on the service due to the TUPe of the clinical psychologist to a different trust and a question as to whether they would be permitted to continue in the service. This TUPe process had meant that the clinical psychology post with the additional resource had to be advertised and recruited to.
• Of the people who received a diagnosis as at the end of August 2016, how many were referred out of area for diagnosis?
To my knowledge since the start of the service no individuals either with or without a learning disability have been referred out of area for a diagnostic assessment but the CCG’s would have specific information around this.
• Did not meet Care Act eligibility criteria to access further support, even though they have received a diagnosis of autism?
We will signpost people to request a Care Act assessment following the diagnostic assessment but do not have details regarding who pursues this and the outcome.
• Please provide comparative reporting period to each of the questions above to demonstrate trend over two historical years previous to the date mentioned above.
This information is provided in the relevant sections above. Page 87 of 130
Support offered • Can you confirm what the process is in your area if someone who has received a diagnosis of autism; does this automatically trigger an offer of a Care Assessment?
As above we will signpost people to request a Care Act assessment following the diagnostic assessment but do not have details regarding who pursues this and the outcome. We are looking at the possibility of incorporating social work time into our service which will enable us to monitor this more closely and be clearer about the process and eligibility for a Care Act Assessment.
• In your area please confirm if reasonable adjustments have been promoted to enable people with autism to access NHS Services including primary care or GP Services, Mental Health and acute Services?
We do not have information to be able to comment with regard to GP services. In acute services there are specialist LD nurse posts in both Basildon and Southend Hospitals, the individuals in these posts can also be contacted to provide potential support to individuals with an Autism Spectrum Disorder or Condition. The Aspergers Service is based in adult services and there are links with the other teams. We have provided some training for the Liaison and Diversion services, the Basildon FRT and RWB teams and some initial training for the Southend FRT and RWB. Currently we are working with the Southend Teams to look at incorporating more specific questions around ASC/ASD into their assessment process and increasing understanding. The Brentwood FRT and RWB teams have requested training in order to improve their understanding of the needs of individuals with an ASC/ASD. We have also made links with IAPT services in south Essex and Thurrock to think with them about services for supporting individuals who have mood related difficulties and ASC/ASD.
• How do NHS Crisis services in your area routinely anticipate and provide for the crisis needs of people with autism? Please provide information of any relevant pathway
The Crisis Teams (CRHTTs) do routinely provide services for the crisis needs of people with autism but without a learning disability.
The lead for the CRHTTs reports that they often come across patients and carers who would benefit from some further support with symptoms of autism and are sometimes unclear as to services available to refer them to. Discussions are underway with the service to attend their team meetings and provide information about the Adult Aspergers Service as well as the supports/services which may be available to access.
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AGENDA ITEM 13
Committee: Health Overview and Scrutiny Committee
Date: 9 November 2016
Outstanding Items Enquiries to: Name : Anna Saunders Designation: Head of Commissioning; People Directorate: People Commissioning Telephone Number: 03330136409 or 07881310750 Email address: [email protected]
Purpose of the Paper:
For Scrutiny to receive information pertaining to Adult Autism Statutory Guidance implemented by the Adult Autism Commissioning Group in relation to the inconsistency of referral routes, waiting lists, and support offered based on where you live in the county.
The Statutory Guidance for Local Authorities and NHS Organisations to implement the Adult Autism Strategy dated March 2015 and Supporting People with a Learning Disability and/or autism who display behaviour that challenges, including those with a mental health condition dated October 2015, has highlighted the need for an Improvement Plan to ensure the Adult Autism Commissioning Group as a partnership meets its statutory responsibilities.
Background
Essex County Council has statutory obligations to support Essex residents who are on the autism spectrum, as well as those who are caring for them.
To meet obligations and goals for supporting adults with autism, the council has created the Adult Autism Strategy which was published in October 2014. This Strategy is to make sure adults with autism get the help they need. The strategy also informs partner agencies and health services how they can help people with autism in relation to statutory guidance.
As part of the Adult Autism Strategy, the Adult Autism Partnership Board has been set up, and meets every three months. The Board was established in 2014 and met in 2015. The Adult Autism Partnership Board discusses services and support in Essex, and looks for ways to improve support in Essex. Members of the Board are from local Government organisations, charities, and Clinical Commissioning Groups
Page 89 of 130 and those who work closely or care for someone with autism, and there are also members who have autism themselves.
The council has followed the national guidance when deciding the purpose of the Board and its membership make up. Services for adults with autism in Southend and Thurrock are the responsibility of the unitary authorities for these areas. However, Essex Country Council is working closely with these authorities to develop a consistent pan Essex approach.
Autism Focused Initiatives Led by ECC
• Creation of the Autism Information Hub within Living Well Essex • Funding towards Advice and Support via Autism Anglia • Funding towards Befriending Scheme via Autism Anglia • Contribution towards Mid and West Essex Early Intervention Support wrapped into Diagnostic Service • Libraries working to become Autism Friendly • Working with Library Service to promote Autism Friendly environments within Libraries. • Disability Confident Employer Scheme sign up
Summary
• The Adult Autism Self- Assessment Framework is submitted to the Department of Health as a record of performance against statutory guidance and to demonstrate achievements in delivering Autism Services for Essex residents against statutory guidance. It also highlights areas that require improvement.
Key Improvements Identified through partnership working:
• Development of a Multi-Agency Training Countywide through the Adult Autism Partnership Board
• Disparity in wait times (CCG responsibility): • Mid Essex CCG: Average time: 23 weeks • West Essex CCG: Average time: 22 weeks • North East Essex CCG: Average time: 41weeks • South Essex CCG: Average time: 72 weeks
Page 90 of 130 AGENDA ITEM 14 HOSC/65/16
Committee Health Overview and Scrutiny Date 9 November 2016
Complex urological cancer surgery in Essex
Report by: Councillor Ann Naylor/ Graham Hughes, Scrutiny Officer Contact details: [email protected] Tel: 03301 34574
1. Purpose
On 1 st April 2015 the Committee gave authority to establish a Joint Committee with Southend and Thurrock Unitaries to review NHS England proposals for the future provision of complex urological cancer surgery in Essex (JHOSC).
2. Background
NHS England has been looking to concentrate the most complex specialist surgery for prostate, bladder and kidney cancers at one centre in Essex. Such surgery is currently provided at both Colchester and Southend Hospitals. An Independent Panel established by NHS England to evaluate the respective bids received from Colchester and Southend Hospitals to host the specialist centre subsequently recommended that it should be located at Southend Hospital.
3. Update
The JHOSC has convened four times and issued its scrutiny report on 23 September 2016 by way of press release (which is attached) together with the summary report of the JHOSC (the full report is accessed via a link within the summary report). The JHOSC made eight recommendations principally around better engagement.
4. Action required
As scrutiny of the further public engagement to be undertaken by NHS England will be undertaken by the Joint Committee, the HOSC is asked solely to note this update.
Page 91 of 130
Page 92 of 130 NHS England proposals for a single complex Recommendations Recommendation 1: urological cancer surgery centre in Essex That NHS England is asked to give a commitment to review A Joint Committee was established by the health scrutiny committees at the single complex surgical each of Essex County Council, Southend-on-Sea Borough Council (Unitary) centre model for urological and Thurrock Council (Unitary) to consider NHS England’s proposal for a cancer in Essex if there are single complex urological cancer surgery centre in the county of Essex and significant future changes to for it to be sited at Southend Hospital (hereinafter referred to as the ‘JHOSC’ population demographics. - being short for a Joint Health Overview and Scrutiny Committee). Recommendation 2: That NHS England provides Case for change greater clarity and detail in its future public Significant clinical evidence shows that fewer and larger centres for complex communications on the urological cancer surgery, which can treat more patients, can have better patient anticipated numbers of outcomes as both clinicians and care staff are able to further build and maintain patients it thinks will be their expertise and skills. impacted by the change. The JHOSC broadly supports the need to embrace change so that patient outcomes Recommendation 3: can further improve although it has had concerns throughout the process so far That NHS England must be around the adequacy and clarity of stakeholder engagement. clear in their future public engagement on this issue Communication that: Patients speak highly of the current service provided by Colchester and (i) The specialised Southend. However, the JHOSC has heard that the NHS England project to arrangements are only for undertake future complex urological cancer surgery in one centre in Essex complex surgery and has ‘injured’ the informal network of user groups and clinicians and created immediate pre and post- animosity by pitching the two hospitals into a contest where some stakeholders operative care and that cannot see the need for change. This has been exacerbated by inconsistent all other care will be (and sometimes inadequate) communication with some patient groups at conducted at a patient’s key times to clarify the proposal which has allowed the spread of rumour and local hospital; misinformation which has worried local people. In particular, the proposed (ii) Current arrangements reconfiguration relates solely to the most complex of urological cancer surgery, for chemotherapy and and only immediate pre and post-operative care for that surgery, which radiotherapy will remain potentially impacts approximately 200 people annually in Essex. unchanged. Recommendation 4: Essex County Councillor Ann Naylor, Chairman of the Joint Committee, said: That NHS England should detail to the JHOSC, and in its “There is clear evidence that patient outcomes are better after complex stakeholder communications, surgery for the rarer types of cancer if surgeons and clinicians are able to the mitigating actions to carry out these operations in fewer and larger specialist surgical centres be undertaken to improve as it helps them build and maintain their expertise. We support the outreach to hard-to- reasons for the centralising of complex urological surgery at one centre in reach groups in future Essex. However, we have had concerns around the adequacy and clarity so that patients are not of stakeholder engagement up to now. Future communications with disproportionately excluded patients and the public needs to make it very clear that the proposed or disadvantaged from reconfiguration relates solely to the most complex of urological cancer the reconfigured service surgery, and only immediate pre and post-operative care for that surgery. on cultural, financial and We are pleased to hear that NHS England have acknowledged that such transport grounds. engagement needs to improve in future.” Continued…
Page 93 of 130 Recommendation 5: That NHS England should Partnership working seek the guidance of The JHOSC would like to see NHS England engaged in more partnership Healthwatch Essex, Southend working with its external stakeholders, including patients, on this and similar and Thurrock, on the reconfiguration issues in future. It has been encouraging that there is now format and reach of future talk about greater collaborative working between hospitals arising from, and stakeholder engagement. a necessity of, the new single centre model in Essex. The on-going holistic support role of the clinical nurse specialists is also critically important in Recommendation 6: making the new model work. That closer monitoring through the Clinical Nurse Specialists is provided for the first cohort of patients using Southend Borough Councillor Cheryl Nevin, Vice Chairman of the Joint the newly launched service. Committee, said:
Recommendation 7: “Working in partnership with our colleagues in Thurrock and Essex we (i) That NHS England were tasked with scrutinising proposals to create a single site for an provides further “Essex wide solution” for Specialist urological cancer surgery. Following information on the future a review of both the Colchester and Southend hospital sites and tender anticipated investment submissions, I am satisfied that NHS England and the Independent into the reconfigured Evaluation panel recommendation has clearly demonstrated that the service and the focus of proposed location at Southend Hospital is in the best interests of such investment; and improving patient outcomes for Essex residents”. (ii) That NHS England provides further information on any anticipated displacement Next steps of other services as a The JHOSC submits this report ahead of NHS England formally considering result of the launch of the the recommendation of the Independent Review Panel and commencing reconfigured service. further public engagement and communication. The JHOSC requests an update from NHS England on project status and the public engagement Recommendation 8: undertaken at year-end. That consideration should be given to re-instating the formal cancer alliance Evidence base network groups that have The JHOSC met four times between July 2015 and December 2016 and during been discontinued or that time spoke to representatives from NHS England, Colchester and Southend establish an alternative hospitals, patient groups and clinical nurse specialists. formal network structure building on the existing informal network. The full report is available online, please click here
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The information contained in this leaflet can be translated,Page 94 of 130 and/or made available in alternative formats, on request. Published September 2016 CDS162178 PressRelease Communications PO Box 11, Chelmsford CM1 1LX 23 September 2016 PR 5843
Essex-wide committee says NHS urological cancer surgery centre proposals must be clearer
Communication from NHS England on its proposal to have a single centre for complex urological cancer surgery in Essex needs to be made clearer, according to a Joint Essex-wide Health Overview and Scrutiny Committee.
A committee comprised of councillors from Essex County Council, Southend and Thurrock councils has been reviewing the NHS England proposal to site the centre at Southend Hospital. The Committee has been looking in particular at how NHS England reached their conclusion of recommending the site at Southend and how they have been communicating and engaging with the public and service users up to now on the proposal.
As part of its review the Committee spoke to patient group representatives and clinical nurse specialists to hear first-hand how they felt the communication process had been managed as well as discussing the proposal directly with NHS England on three separate occasions before and during the procurement process.
Essex County Councillor Ann Naylor, Chairman of the Joint Committee, said: “There is clear evidence that patient outcomes are better after complex surgery for the rarer types of cancer if surgeons and clinicians are able to carry out these operations in fewer and larger specialist surgical centres as it helps them build and maintain their expertise. We support the reasons for the centralising of complex urological surgery at one centre in Essex. However, we have had concerns around the adequacy and clarity of stakeholder engagement up to now. Future communications with patients and the public needs to make it very clear that the proposed reconfiguration relates solely to the most complex of urological cancer surgery, and only immediate pre and post-operative care for that surgery. We are pleased to hear that NHS England have acknowledged that such engagement needs to improve in future.”
The Joint Committee has made eight recommendations to NHS England primarily around future communications and engagement. The Joint Committee would also like to see NHS England engaged in more partnership working with its external stakeholders, including patients, on this and similar reconfiguration issues in future.
Vice Chairman of the Joint Committee and Southend -on-Sea Borough Councillor Cheryl Nevin, said: “Working in partnership with our colleagues in Thurrock and
Page 95 of 130 Essex we were tasked with scrutinising proposals to create a single site for an “Essex wide solution” for Specialist urological cancer surgery. Following a review of both the Colchester and Southend hospital sites and tender submissions, I am satisfied that NHS England and the Clinical Evaluation panel recommendation has clearly demonstrated that the proposed location at Southend Hospital is in the best interests of improving patient outcomes for Essex residents .”
The Joint Committee recommended further public engagement be undertaken as the new service is embedded to aid a smooth transition for patients.
ENDS
Notes to Editors
To read the summary report of the joint Committee please click here Summary Report .
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Page 96 of 130 AGENDA ITEM 15 HOSC/66/16
Committee Health Overview and Scrutiny Date 9 November 2016
PET CT SCANNER FOR SOUTH ESSEX
Report by: Graham Hughes, Scrutiny Officer Contact details: [email protected] Tel: 03301 34574
1. Purpose
The last HOSC meeting agreed the setting up of a Joint Committee with Southend HOSC to operate on a ‘Task and Finish Group’ basis to look at the NHS England proposal to have one fixed site to serve the south of Essex. This is a report of a meeting held on the afternoon of 15 September 2016 and the subsequent report from the JHOSC sent to NHS England.
2. Background
In October 2015 the HOSC considered proposals by NHS England to establish a single site location for a Positron Emission Tomography (PET) scanner for south Essex. Options for siting it at either Basildon Hospital (where a mobile service has been operating) or at Southend were being considered. A number of concerns were raised at the time including local clinical and patient engagement and NHS England agreed to review this further.
There is now a recommendation for the site to be at Southend Hospital and the JHOSC has considered the proposal and issued its report supporting that proposal (see Appendix). Thurrock HOSC chose not to participate in the JHOSC and, instead, discussed the proposal with NHS England in a separate meeting. Thurrock HOSC did not agree with the recommended site for the fixed scanner and have referred the matter to the Secretary of State.
3. Proposal
The HOSC is asked to note:
(i) The conclusions of the JHOSC meeting of the 15 th September 2016 summarised in the letter to NHS England dated 20 September 2016; (ii) That Thurrock HOSC have subsequently referred the NHS England proposal to have the fixed site at Southend Hospital to the Secretary of State; and (iii) That the JHOSC will be writing to the Secretary of State to highlight its role and conclusions. Page 97 of 130
Page 98 of 130
Members’ Suite PO Box 11, County Hall, Chelmsford CM1 1LX Email: [email protected]
20 September 2016 BY EMAIL
Ruth Ashmore, Assistant Director of Specialised Commissioning. NHS England Specialised Services (Midlands and East of England) c.c. Jessamy Kinghorn Head of Communications and Engagement NHS England Specialised Services (Midlands and East of England)
Dear Ruth
SOUTH ESSEX PET-CT SERVICE REVIEW
I write further to the meeting you had on Thursday 15 th September 2016 with a Joint Health Scrutiny Committee (JHOSC) comprising members from Essex County Council and Southend Borough Council, which was specifically established to look at the proposal to site a PET CT Scanner to serve south Essex at Southend Hospital. In advance of the meeting the JHOSC was provided with a report from NHS England, the Clinical Senate Report, further information on your stakeholder engagement and some public transport analysis.
This issue has been longstanding having originally been presented to the Essex, Southend and Thurrock HOSCs last October. At that time the proposal was not well received at either the Essex or Thurrock HOSCs although supported by the Southend committee. The main criticisms had been lack of local clinical engagement, lack of local patient engagement, further information being required on likely patient treatment pathways after such a scan, the impact on patient travelling times and the independence of the review and the extent of any commercial pressure in the decision making process.
The JHOSC is pleased that, since October 2015, NHS England has sought to address each of the above criticisms. You have undertaken more research into the patient pathway in South Essex and the clinical benefits of co-location with different
Page 99 of 130 services, engaged with local clinicians, patients and public and detailed how a decision would be made. Subsequently, you commissioned an independent clinical review of the case for change from the Clinical Senate.
Last week you highlighted the significant 30% growth in the demand for the service in the last year which had exceeded the anticipated 12% growth trajectory. You advised that a fixed rate scanner site would be able to absorb this rate of growth. The Clinical Senate had advised that 20% may be a more realistic future rate of growth in demand for the service. However, you did also acknowledge that if such growth continued at such a rate then a second site for a scanner in south Essex could be considered in the future. The contract with the provider stipulated that any such further site would need to be fixed
During our discussion last week the JHOSC particularly noted that:
- The PET CT Scanner decision was separate to the Success Regime. The Success Regime has made it clear that radiotherapy is to stay at Southend. The south Essex PET CT scanner service was the only service in the region not co-located with radiotherapy. - Under the Success Regime there would be further opportunities for the three acute hospitals in mid and south Essex to work together and network services as part of ensuring the on-going sustainability of all three of them. - Establishing a fixed site at Basildon Hospital would take 12 months although local clinicians thought it would be nearer 9 months. The JHOSC were concerned about the amount of time already lost in finalising a decision; - There are issues around the capacity, maintenance and down-time of the mobile service; - There is no difference in financial cost to NHS England which site was used as the contract with the provider was based on number of scans delivered (i.e. it is an output-based contract). - The need for a continued focus on hard-to-reach groups had already been recognised by NHS England and some mitigation was planned; - The JHOSC highlighted that the Clinical Senate Report recommended that further work is done to ensure those with difficulty in travelling to the proposed site are given adequate assistance and support. You advised that patients not physically mobile were likely to be eligible for financial support and hospital transport and that you continued to work with local CCGs on their eligibility criteria for these services; - In patient engagement undertaken by you many of the responses were parochial in where they wanted to see the service located although patients’ biggest priority was how easy it was to be seen and how quickly they could access the service; - You confirmed that senior management at both Basildon and Southend Hospitals supported the proposals and that local clinicians from both Trusts recognised the ‘direction of travel’.
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In supporting the proposal to site the scanner at Southend, the JHOSC has made three recommendations:
Recommendation1:
Cognisant of the delay in finding a solution and that significant time had been lost, the JHOSC supports the proposal as submitted and encourages NHS England to implement it as soon as possible to ensure that capacity can be quickly increased enabling earlier diagnosis and improved patient outcomes.
Recommendation 2:
That NHS England need to be clear in their future communications to distinguish this project from the Success Regime and Urological cancer.
Recommendation 3:
That NHS England reports back to the JHOSC in six months’ time to update it on implementation.
Should you require any further information or clarification then please do not hesitate contacting Graham Hughes, the Scrutiny Officer supporting the Essex HOSC.
Yours sincerely
Councillor Andy Wood Chairman Joint Health Scrutiny Committee To review location of PET CT scanner service for South Essex
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Page 102 of 130 AGENDA ITEM 16
HOSC/67/16
Committee Health Overview and Scrutiny Date 9 November 2016
TASK AND FINISH GROUP: UPDATE
Report by Graham Hughes, Scrutiny Officer Contact details: [email protected] Tel: 033301 34574
Recommendation:
(i) The Committee is asked to note the update given below on the Task and Finish Group established by the Committee; and (ii) Approve the attached updated Scoping Document for the Group which incorporates the Membership and Terms of Reference for each Group. ______
Background:
On 1 st June 2016 the Committee resolved to establish a Task and Finish Group to look at mental health services for children and young people. This had been prompted by the publication of the YEAH 2! Report by Healthwatch which indicated a number of issues around profile and accessibility of services in Essex.
Terms of Reference
The Group has now held six meetings and through hearing from a Commissioning Director at Essex County Council, North East London Partnership Trust (the new provider of services) and Healthwatch, now has a grounding in the context and structure of current services, and some of the key issues, and will now be establishing a work programme to speak to other witnesses. The Group aims to conclude its review by February 2017.
The current Scoping Document for the Group is attached which incorporates the proposed on-going membership. These remain working documents and may change further during the life of the review to reflect changes in emphasis, new contributors, and/or issues emerging during the study.
Action requested:
The Committee is asked to approve the current Scoping Document, as presented, on the basis that any subsequent material change to it will be reported back to the Committee for endorsement. Page 103 of 130
Page 104 of 130 Essex County Council Overview and Scrutiny Committee Review Scoping Document ( DRAFT 2 – 13 OCTOBER 2016)
Mental Health services for children and young people Review Topic
Committee Health Overview and Scrutiny Committee
(i) To provide Members with an improved understanding of issues and trends in connection with mental health services for children and young people; (ii) To review the new Emotional Wellbeing and Mental Health Service launched by a new provider including capacity and demand issues; Terms of Reference (iii) To review issues about services raised by service users and patients, and other sources, using anecdotal evidence, local research material such as YEAH 2 from Healthwatch Essex and conducting witness sessions as appropriate; (iv) To consider any changes that could be recommended
District Councillor J Beavis County Councillor Keith Bobbin
Southend Borough Councillor Helen Boyd Lead Member, and County Councillor Jenny Chandler (P&F Scrutiny Cmtee nominee) membership of Task Southend Councillor Caroline Endersby and Finish Group County Councillor K Gibbs
County Councillor Jill Reeves County Councillor Andy Wood
Key Officers / Barbara Herts, Director for Commissioning Mental Health Departments Clare Hardy, Head of Commissioning.
Lead Scrutiny Officer Graham Hughes
Portfolio Holder(s) Councillor Graham Butland, Cabinet Member for Health
Corporate Outcomes Framework -
Children in Essex will get the best start in life (Children and young people are well looked after and safe with their basic needs being Relevant Corporate met within resilient families and that they are emotionally healthy and Links make good decisions)
People in Essex enjoy good health and wellbeing (ensuring that mental health services are fit for purpose)
Page 1051 of 130
Type of Review Task and Finish Group
Timescales Completion by February/March 2017
Two of Essex County Council’s desired Corporate Outcomes are that Children in Essex will get the best start in life and that People in Essex enjoy good health and wellbeing.
Both national and local reports have suggested that there are issues around information being available about services, referrals to services, accessing services, transition between services, and the suitability of services for children and young people.
In particular, in the summer of 2016 Healthwatch Essex published YEAH2 – a report on young people’s experiences of accessing and using local health services (with a particular section focussing on Rationale for the mental health). The YEAH! 2 report states that young people are Review asking for more information to be published about services in order to help raise awareness and highlight the fact the type of services available do not always meet their expectations and needs. Difficulties around the transition between children and adults services are also highlighted.
A new contract for providing services to children and young people has been operational since 1 November 2015 and it is also opportune to assess the challenges being faced, and the changes being made and planned by the new provider (North East London Foundation Trust).
To identify and review:
(i) awareness and signposting of services Scope of the Topic (ii) referral and waiting times to access services
(iii) the links between and to services (iv) consistency of services (v) appropriate budget and finance issues and impacts
(i) Is there clear leadership on mental health? (ii) Do young people know where to go for support and is it accessible? (iii) What service standards are in place on how mental health Key Lines of Enquiry services should be provided? (iv) How are services linked and integrated? (v) How prominent is prevention and early intervention? (vi) How do current budgets and finances impact the services being provided?
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Children’s Commissioner: Lightning Review: Access to Child and Adolescent Mental Health Services - May 2016 Centre Forum Commission on Children and Young People’s Mental Health – State of the Nation – April 2016 Other Work (Being) Hope for Better Mental Health – exploring co-production and Undertaken recovery – Essex County Council Healthwatch Essex YEAH, YEAH 2 and SWEET reports. Healthwatch Essex YEAH 3 (underway) Updating of Joint Strategic Needs Assessment on Mental Health (underway) Mental Health Strategy review (underway)
What primary / new Awareness, signposting and services in schools, youth services. evidence is needed for The role of the voluntary sector/third sector the scrutiny?
What secondary / See Other Work (being) Undertaken existing information will be needed? Briefings: ECC Commissioner for children’s/young people’s mental health
services. What briefings and Service provider (North East London Foundation Trust) site visits will be relevant to the review? Site Visits:
Local schools Youth projects Provider – North East London Partnership Trust
Schools: ECC Educational Psychologist(s) Youth Offending Teams (YOTs) Social Workers with youth offenders Schools council School nurse Who are the witnesses Pastoral care provision who should be invited School Co-ordinators to provide evidence for the review? Youth services Youth projects and similar ECC Youth Bus YMCA
Role of Voluntary/Third sector (e.g. MIND, YMCA)
Others to be determined
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In terms of topic, have the following matters been taken into consideration in the planning of this review:
Implications Legal implications Yes/ no Financial implications .. Yes/ no Equality and diversity issues .. Yes/ no Other critical implications
At present it is difficult to quantify the additional resources required to What resources are undertake this review. Given that the resource available is finite, it will required for this be necessary to consider carefully the timing of the review within the review? Committee’s overall work programme.
That the Group obtain assurance that children and young people
have a mental health service that is accessible and fit for purpose Indicators of Success and any gaps or weaknesses identified by the review can be
improved.
Notes
Provisional Timetable Completion by February/March 2017
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AGENDA ITEM 17
HOSC/68/16
Committee Health Overview and Scrutiny Date 9 November 2016
To consider the update report (HOSC/68/16) from NHS England on Regional specialist commissioning.
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Page 110 of 130 SPECIALISED SERVICES IN ESSEX: AN UPDATE
Paper to the Essex Health Overview and Scrutiny Committee – November 2016
1.0 Introduction
In June 2016, a team from NHS England’s local specialised commissioning team provided the Health Overview and Scrutiny Committee with an overview of specialised commissioning and future plans for specialised services. This paper aims to provide the committee with an update on the key national and local service reviews that are taking place. There is currently not expected to be any significant service change proposal within the next twelve months that the committee is not already aware of.
2.0 Background
Specialised services are complex, rare, high cost services, which are often a catalyst for innovation and pioneering clinical practice. Over 140 specialised services are commissioned by NHS England to national standards, each service providing a service for populations of more than one million. Specialised services account for approximately £15 billion per year – 14% of the entire NHS budget.
In the Midlands and East of England, the budget for specialised services is £3.7billion - £1.1 billion of which is spent in the East of England. The largest providers of specialised services in the East of England are Cambridge University Hospitals, Norfolk and Norwich Hospital, Papworth Hospital and Partners in Care.
A new, national strategy is being developed for specialised services to help deliver the Five Year Forward View. This will mean fewer, larger providers for some elements of care to ensure services can meet the standards and be sustainable. It will mean an increase of hub and spoke networks, new commissioning models and increased emphasis on performance and quality monitoring and managed entrance of new drugs and interventions.
3.0 Service reviews
Local service reviews are normally conducted where the local service is consistently not meeting agreed national standards. This could be due to a number of reasons, such as the size of the service resulting in insufficient numbers of patients per surgeon, a longstanding inability to recruit the necessary levels of qualified staff, or poor patient. Service reviews could also be conducted across a geographical area where there is evidence that services could be more efficiently coordinated to benefit patients.
National reviews are determined and prioritised by the national team and the six programmes of care. All services need to be reviewed regularly to ensure standards are maintained. National reviews can lead to recommendations for a reconfiguration of local services.
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1/4 4.0 Service change in Essex during 2016/17
4.1 Specialised Urological Surgery
In Essex, specialised urological surgery does not meet the national service specification and has been subject to a review. Following a lengthy process of engagement and clinical evaluation of bids from providers, a decision has been made to bring the two existing services together into one service which will be based at Southend. This has been previously discussed with the Joint Health Overview and Scrutiny Committee and the existing providers are working together to implement changes to the service by April 2017.
4.2 PET-CT in South Essex
The PET-CT service in South Essex has been reviewed following a request by the provider to move the service. Following engagement with a joint Essex and Southend Health Overview and Scrutiny Committee which supported the recommendation and a separate Thurrock Committee which has subsequently referred the matter to the Secretary of State, a decision by NHS England is pending. There has been an unexpectedly large increase in demand which may necessitate an interim solution before a decision is made on a permanent resolution.
4.3 Specialised Vascular Services
Specialised vascular services are currently the subject of a regional review. Essex has had a number of vascular surgical reviews in recent years but for a number of reasons, recommendations to make changes to the service have not been enacted. The vision for vascular care in Mid and South Essex is now being developed through the Essex Success Regime with the vascular clinical leads at Basildon and Thurrock University Hospitals NHS Foundation Trust, Mid Essex Hospital Services NHS Trust and Southend University Hospital NHS Foundation Trust working closely together to discuss and develop future options for the delivery of specialist vascular care in mid and south Essex. This will form part of the Essex Success Regime proposals.
4.4 HIV services in Essex
NHS England commissions the HIV care and treatment element of the sexual health pathway. Following changes to the responsibilities for commissioning sexual health services to local authorities, Essex County Council has awarded a new contract for sexual health services to Provide as the lead provider in a consortium which includes South Essex Partnership NHS Foundation Trust, Colchester Hospital University NHS Foundation Trust and Basildon and Thurrock University Hospitals NHS Foundation Trust. The contract began on 1st April 2016, following which time, Princess Alexandra Hospital NHS Trust has formally given notice to NHS England for the HIV Care and Treatment Service that they will cease to provide the service from 1st April 2017. Since the start of the new contract, patient pathways have become fragmented across the area. The HIV services were the smaller part of the integrated service and this has resulted in staffing and premises issues now that the supporting infrastructure and staffing has been transferred to new providers. This experience is replicated in other areas of the Midlands and East of England. The Specialised Commissioning Team is working with the trust to ensure that services are continued in the short term, whilst a sustainable long term solution is identified. The team has undertaken an
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2/4 option appraisal and sought procurement advice. As a result, an Intention to Tender Notice has been advertised with the award of a new contract planned for January 2017 to ensure robust and sustainable HIV services delivered in the area from 1st April 2017. Once the procurement process has identified suitable providers, the Overview and Scrutiny Committee will be updated on the options and engaged in any changes to the service that may be necessary.
4.5 Child and Adolescent Mental Health inpatient services (CAMHS Tier 4), Adult Medium and Low Secure Services and Perinatal inpatient mother and baby units and linked outreach services
In March 2016, NHS England set up a national Mental Health Service Review Programme to support a detailed and comprehensive service review of these services. The aim is to offer care in certain specialised services closer to home, more effective care pathways that facilitate discharge from inpatient care at the earliest opportunity and enabling where possible people to be cared for in their local communities. A needs assessment has been taking place to ensure capacity is balanced geographically, looking at access to services closer to home, integration of health and care services and sustainability of the services.
This assessment process is due to report this autumn and any requirements for local changes are then expected to be planned over the next two years. New money has been identified for additional mother and baby beds for existing units serving the Essex and Hertfordshire population. Procurement of these beds begins in November 2016 with the aim of announcing contract awards at the end of March 2017. A national 60 day consultation is taking place this autumn, ending December 2016 on a number of CAMHS service specifications, including specifications dealing with the required Psychiatric Intensive Care, Forensic Outreach, and Low and Medium Secure standards. Once agreed, these specifications will become the standards for commissioning and assessing CAMHS services in future. This will need to be completed, along with the needs assessment before any consideration of the configuration of regional services can begin..
4.6 Transforming Care Partnerships (Learning Disabilities)
The national Building the Right Support Programme has 48 local Transforming Care Partnerships working on plans to change services in a way that will make a real difference to the lives of children, young people and adults with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition. Southend, Essex and Thurrock Transforming Care Partnership’s (TCP) plan will begin by investing in community roles and resources to help people with a learning disability and/or autism settle into the community, and improve how it plans to discharge people from hospital. This will include new housing schemes and a community based service for people who are at risk of getting into trouble with the law. Moving on, the focus will be more transformation and prevention work for both children and adults. To do this the TCP will improve access to housing, leisure and health support. At the same time, it will make sure that specialist services for people with a learning disability and/or autism shift from hospitals and into the community. In Essex in December 2015, there were 28 people in NHS England commissioned inpatient beds, seven of whom had been in hospital for more than five years.
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3/4 National modelling shows that there should be 20-25 inpatients per million in NHS England funded Secure beds which would be 29-36 placements in Essex. Numbers of NHS England funded secure beds, including CAMHS are broadly in line with national expectations so there is unlikely to be significant change affecting the Essex population.
4.7 Congenital Heart Disease (CHD)
CHD services have been reviewed nationally and a public consultation is due to launch before the end of 2016 on proposed changes to the configuration of the service to ensure it meets agreed clinical standards. There is no CHD centre in Essex but we are supporting the national team to understand whether Essex patients may be affected by the proposed changes to centres within the Midlands and East of England and London. Once this work is complete, we will keep local Scrutiny Committees informed of any expected impact.
4.8 Intestinal Failure
A national exercise to re-procure Type 2 and 3 specialised Intestinal Failure services has been paused following an audit of current activity and to enable further work on the tariff for the service. Type 2 services are surgical and medical services provided in specialist centres, type 3 services are medical services and oversight of parenteral nutrition services which are coordinated by a hospital but delivered at home. There are two highly specialised centres in England – one in Salford and one in London. The whole of the Midlands and East region treats just over 60 patients per year for Type 2 services and just over 280 patients per year for Type 3 services. A very small proportion of these are Essex patients, some of whom have their care coordinated by Basildon and Thurrock University Hospitals NHS Foundation Trust. To meet national standards, a centre needs to treat a minimum of ten patients per year for Type 2 services and 20 patients for Type 3 as daily specialist input is required from GI clinicians, along with adequate nursing specialty and pharmacy availability. Engagement will take place with all existing providers and patient groups over the future provision and configuration of services to ensure patients are able to access the specialist care they need, prior to a procurement exercise. The timescale for this work is pending.
5.0 CONCLUSION AND RECOMMENDATION
This document provides an update on a number of areas of potential service change within specialised services. Three of these are being dealt with separately by Oversight and Scrutiny Committees in Essex and are only mentioned briefly here. The remaining services covered in this paper are subject to national reviews but not expected to undergo significant change within Essex. They are included here for briefing purposes and further information can be provided on request or presented at a later date when any potential impact on Essex patients is clearer.
The Committee is asked to NOTE this report.
Paper prepared by: Jessamy Kinghorn, Head of Communications and Engagement, and Ruth Ashmore, Assistant Director of Specialised Commissioning for the East of England.
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4/4 AGENDA ITEM 18
HOSC/69/16 Committee Health Overview and Scrutiny Date 9 November 2016
GENERAL UPDATE
Report by Graham Hughes, Scrutiny Officer Contact details: [email protected] Tel: 03301 34574
This report is in two parts – Part 1 provides general local health issues and items of interest. Part 2 relates to variations and changes to services that the HOSC has been notified of, usually relating to primary care.
Recommendation: If there are no issues arising, to note the updates in Part 1 and Part 2 below: ______
(i) LOCAL HEALTH NEWS
Health bodies - Public meetings 2016/17
A list of forthcoming meeting dates for CCGs, Acute Trusts and Essex Mental Health Services is attached for your information ( Appendix 1). If members attend any of these meetings can they please feed-back to the HOSC any significant or topical issues that may be of interest to the wider committee membership.
Local Clinical Commissioning Groups – news
Web addresses http://www.basildonandbrentwoodccg.nhs.uk/news http://castlepointandrochfordccg.nhs.uk/news-a-events http://www.midessexccg.nhs.uk/news-events http://www.neessexccg.nhs.uk/News%20and%20Events/News/Current%20News.ht ml http://www.westessexccg.nhs.uk/news Page 115 of 130 Acute Trusts
Mid Essex Clinical Commissioning Group (CCG) is working with Mid Essex Hospital Services NHS Trust (MEHT) and other healthcare partners to redirect patients going to A&E with conditions that are not serious to more suitable NHS services. Signs are up around Broomfield Hospital and in the car park to explain the redirection
Analysis indicates that at least a fifth of Broomfield’s current A&E patients do not have a serious or life-threatening condition but the long waits in A&E are not putting them off walking in with minor ailments.
Instead, the CCG are working with local GP practices to make sure appointments are available.
Care Quality Commission
On 13 October 2016 the Care Quality Commission published their annual ‘State of Care’ report. This is an annual report on the quality of health and social care in England. The report can be found here .
The statement issued by the CQC to accompany the report is reproduced below:
------The report shows that, despite increasingly challenging circumstances, much good care is being delivered and encouraging levels of improvement are taking place.
We have seen services providing good and outstanding care and making improvements by collaborating outside traditional organisational boundaries - hospitals working with GPs; GPs working with social care and all services working with people who use services.
However, we are also seeing some deterioration in quality, and some services are struggling to improve. We raise concerns that the sustainability of the adult social care market is approaching a tipping point. The fragility of the market is now beginning to impact both on the people who rely on these services and on the performance of NHS care. The combination of a growing and ageing population, more people with long-term conditions, and a challenging economic climate means greater demand on services and more problems for people in accessing care.
Our key findings
Most health and adult social care services in England are providing good quality care, despite a challenging environment, but substantial variation remains.
• As at 31 July 2016, 71% of the adult social care services that we had inspected were rated good and 1% were rated outstanding. Of the GP practices we inspected, 83%Page were 116 rated of 130as good and 4% as outstanding and 51% of the core services provided by NHS acute hospital trusts that we inspected were rated as good and 5% as outstanding. • However, some people still received very poor care. We rated a minority of services as inadequate: 2% of adult social care services, 3% of GP practices and 5% of hospital core services.
Some health and care services are improving, but we are also starting to see some services that are failing to improve and some deterioration in quality.
• Of those services that we re-inspected following an initial rating of inadequate, 76% achieved an improved rating: 23% went from inadequate to good and 53% went from inadequate to requires improvement. • However, this still means that a quarter of services originally rated inadequate that did not improve enough to change their overall rating on re-inspection. In addition, 47% that were re-inspected following a rating of requires improvement did not change their rating. In 8% of cases, the quality of care deteriorated so much that we rated it inadequate.
The majority of GP practices are providing good quality care and leading the change in service design.
• Despite a context of increased demand, coupled with a shortage of GPs and increasing vacancy levels, 83% of the GP practices we have rated so far are good and 4% are outstanding. Some general practices have joined together in federations and formed new models of care, involving people who use their services in their conversations from an early stage.
Adult social care services have been able to maintain quality, but there are indications that the sustainability of adult social care is approaching a tipping point.
• Of the care homes and home care agencies that we had rated as inadequate, 77% had improved when we re-inspected. We are seeing some providers starting to hand back home care contracts as undeliverable. Until recently, the growth in demand for care for people with greater care needs had been met by a rise in the number of nursing home beds, but this bed growth has stalled since April 2015. • We are concerned about the fragility of adult social care and the sustainability of quality. This is a serious issue for the continuity and quality of care of people using those services, and for the knock-on effects across the whole health and care system: more A&E attendances, more emergency admissions, more delays to people leaving hospital, and more pressure on other services.
Hospitals are under increasing pressure.
• Despite financial challenges, we have found much good and outstanding care, particularly in children’s and young people’s services and critical care. Page 117 of 130 • But we have also found too much acute care that we rated inadequate, particularly urgent and emergency services and medical services. It will be increasingly difficult for NHS trusts to make improvements to these services unless they are able to work more closely with adequately funded adult social care and primary care providers. • The quality of care received in NHS mental health trusts is broadly similar to that in acute trusts, but with an even higher level of variability within providers as well as between them, and with particular concerns around the safety of acute mental health services.
The sustainability of quality.
• Our evidence suggests that finance and quality are not necessarily opposing demands; many providers are delivering good quality care within the resources available, often by starting to transform the way they work through collaboration with other services and sectors. However, sustained support will be needed for new models of care to become established and improve, and investment will be needed to support leadership and enable the desired transformation. • We will continue to highlight good and outstanding care, to support improvement and to take action to protect people where necessary. And we will continue to use the unique and detailed information we hold on quality, to help those that lead, work in and use health and care services to make the right decisions. • People have a right to expect good, safe care. Working with our partners, we will offer whatever support we can to make the changes necessary to ensure high-quality care into the future.
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(ii) SERVICE CHANGES AND VARIATIONS (including consultations)
Primary care
------
Grafton Surgery, Central Canvey Primary Care Centre, Canvey Island
GP Healthcare Alliance has been providing GP services at Grafton Surgery since 15 August 2016 – this replaced the previous arrangement with Oaklands Surgery that looked after Grafton patients for the six weeks prior to this date. Both arrangements were in place due to action by the CQC which resulted in an urgent cancellation of the CQC registration of Grafton Surgery, Canvey Island under section 30 of the Health and Social Care Act 2008.
From 1 September 2016 patients have had two full time GPs working at Grafton Surgery along with Advanced Nurse Practitioners. Extra locums have also been arranged to help support the clinical staff that will be working there.
The lead GP partner appealed against the decision to cancel the CQC registration. The CCG was informed on 31 August 2016 that this appeal was dismissed.
NHS Castle Point & Rochford Clinical Commissioning Group (CCG) has now received a letter from the partners of Grafton Surgery, Dr Noorah & Dr Ramjan confirming that they have taken the difficult decision to terminate the contract they hold to deliver General Medical Services.
The existing arrangement with GP services being carried out by GP Healthcare Alliance will continue while the CCG looks at options for a permanent solution. The CCG is committed to securing a permanent service for patents at the Grafton Practice from the same location.
Acute Trusts
Colchester Hospital University Foundation Trust is proposing changes to its services at the midwife-led unit at the Fryatt Hospital (also known as Harwich Hospital).
Currently, the unit sees a small number of women with low-risk pregnancies having a midwife-led delivery. It also offers a range of other services including outpatient prenatal, antenatal and consultant-led clinics. The unit is staffed from 9am to 5pm, with births outside these hours being led by on-call midwives who serve the wider area.
Page 119 of 130 These potential changes may mean that, although the majority of services currently offered at the unit would remain, patients may no longer have the option to give birth there from 1 st April 2017. Women would instead be offered the choice of giving birth at Colchester General Hospital’s consultant-led unit or, for uncomplicated births such as those currently seen in Harwich, the option of having a home birth; or having their baby in the midwife-led units in Colchester General Hospital’s Juno Suite or Clacton Hospital.
If the changes go ahead, patients would continue to be able attend antenatal, postnatal and consultant clinics in Harwich, as well as other maternity services.
The Trust has stressed that this potential change is due to the low numbers of babies being born at the unit and the consequent financial implications of keeping the unit running. Last year (2015/16) just 44 babies were born at the unit, fewer than one a week on average, despite a facility of this size meaning it could deliver up to 1,000 babies a year. This number is falling year on year.
The low numbers of births at the unit has driven up the cost of each delivery. Each birth at the unit costs £8,000, yet the maximum income received under the national tariff is £2,000, therefore the Trust is losing at least £6,000 for every delivery.
If this change goes ahead, postnatal and antenatal services would continue in Harwich, as well as the consultant-led outpatient clinic for high-risk patients; a birth choices clinic for women considering whether to give birth vaginally or via caesarean section; hypnobirthing classes and breastfeeding workshops.
The impact on the Colchester and Clacton units, which are both around 19 miles from Harwich, is expected to be neutral due to the small numbers.
NHS England
Re: Integrated Urgent Care (NHS 111/Out of Hours) Service Procurement
Essex CCGs have been working collaboratively in the last six months towards commissioning a new Integrated Urgent Care service (formerly NHS 111 and Out of Hours services) in line with the national commissioning standards.
During the finalisation of the specification and preparing for procurement, the scope has been reviewed and it has become apparent that West Essex requires a significantly different service model to avoid duplication with the out of hospital model being developed in their area. West Essex CCG has therefore taken the decision to withdraw from the project. The procurement will go ahead as planned with the five mid and south Essex CCGs, who are part of a single Sustainability and Transformation Plan footprint.
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NHS Basildon and Brentwood Clinical Commissioning Group
The outcome of the CCG’s recent Fit for the Future public consultation on potential changes to the local Service Restriction Policy and Intermediate Care Services will now be considered at the next public Board Meeting of Basildon and Brentwood Clinical Commissioning Group on Thursday 24 November, 2016.
This follows the decision to defer the previous Special Board Meeting scheduled for 29 September, 2016.
The Fit for the Future consultation closed on 12 September 2016 and all responses received by the CCG during the consultation, together with the feedback provided in a variety of public meetings and events, has been compiled into a report to be discussed at the Board Meeting on 24 November.
The Board meeting will be held in the board room at Basildon and Brentwood CCG, Phoenix Place, Christopher Martin Road, Basildon SS14 3HG. The start time for the meeting is 1.15pm.
Copies of the agenda and public papers for the Board meeting will be available to download at http://basildonandbrentwoodccg.nhs.uk/about-us/board-meetings- papers/2016-board-meetings prior to the meeting.
Mid-Essex CCG
The ME CCG is currently considering a move to fully delegated primary care commissioning (GP services). In developing their plans, they are currently engaging with their primary care colleagues regarding the move to take on such full responsibility from 1 April 2017.
The CCG believes that delegated commissioning will give them more influence over the wider NHS budget and opportunity to develop a more integrated approach to improving healthcare for the local population.
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Page 122 of 130 Appendix 1
Essex Clinical Commissioning Groups - Board Meeting dates 2016/17
Date Time Location Event
24 November 13:15 The Board Room Basildon and Brentwood Phoenix Place CCG Basildon
24 November 14:00 Audley Mills Education Castle Point and Centre Rochford CCG 57 Eastwood Road Rayleigh SS6 7JF
1 December 13:30 Braintree Town Hall Mid Essex CCG Market Square Braintree CM7 3RG 26 January 2017 13:30 The Barn Mid Essex CCG Spring Lodge Community Centre Powers Hall End Witham CM8 2HE
29 November 14:30 St James Church Hall North East Essex CCG Tower Road Clacton on Sea C015 1LE
24 November 9:30 Conference Room, West Essex CCG Harlow Health Resource Centre Harlow 26 January 2017 9:30 Conference Room, West Essex CCG Harlow Health Resource Centre Harlow
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Appendix 1
Acute Trusts – Board of Directors Meeting dates 2016/17
Date Time Location Event
7 December 14:30 The Essex Basildon and Thurrock Cardiothoracic Centre University Hospitals Rooms 4/5 NHS Foundation Trust – Basildon and Thurrock Board of Directors Hospital meeting
23 November 13:30 Postgraduate Medical Colchester Hospital Centre, Colchester University NHS General Hospital Foundation Trust – Board of Directors meeting 28 February 2017 13:30 Postgraduate Medical Colchester Hospital Centre, Colchester University NHS General Hospital Foundation Trust – Board of Directors meeting
5 December 13:30 Lecture Theatre 1 Mid Essex Hospital Medical Academic Unit Services NHS Trust – (MAU) Trust Board/Board of Broomfield Hospital Directors meetings Court Road Broomfield CM1 7ET 6 February 2017 13:30 Lecture Theatre 1 Mid Essex Hospital Medical Academic Unit Services NHS Trust – (MAU) Trust Board/Board of Broomfield Hospital Directors meetings Court Road Broomfield CM1 7ET
7 December 9.30 The Boardroom Southend University Education Centre Hospital NHS 2nd floor Foundation Trust – Southend Hospital Trust Board meetings
Not currently Not Trust Board Room The Princess Alexandra available currently (Lower Ground Floor) Hospital NHS Trust – available The Princess Alexandra Hospital Hamstel Road Harlow
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Appendix 1
Essex Mental Health Services - Meeting dates 2016/17
Date Time Location Event
Not currently Not Stapleford House North Essex Partnership available currently 103 Stapleford Close University NHS available Chelmsford Foundation Trust – CM2 0QX Public Board Meeting
30 November 10:30 Training Room 1 South Essex Partnership The Lodge University NHS Runwell Chase Foundation Trust – Wickford Board of Directors SS11 7XX Meeting 25 January 2017 10:30 Training Room 1 South Essex Partnership The Lodge University NHS Runwell Chase Foundation Trust – Wickford Board of Directors SS11 7XX Meeting
NOTE :
Agendas are normally published one week before public meetings. Please check the time and venues in case there have been any changes.
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Page 126 of 130 AGENDA ITEM 19
HOSC/70/16
Committee Health Overview and Scrutiny Date 9 November 2016 Report by: Graham Hughes, Scrutiny Officer
Work Programme 2016/17 Purpose of report
The purpose of this report is to consider the current Work Programme and invite discussion on future items both for the full Committee and detailed scrutiny to be undertaken both in full Committee and by smaller specific Task and Finish Groups.
Scheduled Work Programme
The agreed focus for the remainder of the 2016/17 HOSC work programme:
(i) Community healthcare (taking in primary care, development of hubs and mental health and expanding and facilitating prevention) – this mirrors one of the two main work streams identified by the Success Regime to develop and integrate Local Health and Care services in the community.
(ii) Transformation of services – the HOSC should be consulted on service reconfigurations/variations.
- Under the Success Regime this can be expected to focus largely on acute services initially – this mirrors a main work stream identified by the Success Regime ( In Hospital – further collaboration and service redesign between the three main hospitals in mid and south Essex).
- Sustainability and Transformation Plans being developed in the north east and west of Essex
(iii) Mental Health - Task and Finish Group looking at services for children & young people - Merger proposals for the two Essex Partnership Trusts
HOSC members are encouraged to continue discussions on the future format of scrutiny work (“ways of working”) to facilitate the above focus.
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2016 briefing and preparation days
Members are invited to suggest future items/issues for briefings – please discuss these with the Scrutiny Officer.
Other briefing dates may be arranged as preparatory sessions for future formal HOSC business. It is likely that one or two of these sessions will be arranged January-March 2017
Offsite Visits Members are invited to suggest any visits that they think may be relevant and beneficial to the Committee.
Action required by the Committee at this meeting:
(i) To continue to discuss “ways of working” for the HOSC;
(ii) Make any suggestions for future briefings and/or site visits;
Page 128 of 130 HEALTH OVERVIEW & SCRUTINY COMMITTEE – WORK PROGRAMME SNAPSHOT AS AT 1 NOVEMBER 2016: APPENDIX Current scheduled work (in Current work (in Task and Future work to be scheduled (in Future work to be scheduled Full Committee) Finish Group) Full Committee) (in Task and Finish Group) Update on amendments to Joint Committee - Urological Local Health and Care services in Local Health and Care Service Restriction Policy and Cancer Surgery proposals (with the community services in the community Intermediate Care provision Southend and Thurrock) (TBC) (Basildon and Brentwood CCG Board) (TBC) Mental Health Joint Committee - PET CT Transformation of Services – Mid Transformation of Services – - Merger of (mental Scanner for south Essex and South Essex Success Regime Detailed scrutiny of specific health) partnership trusts proposal (with Southend) overall project updates Mid and South Essex Success - Strategic oversight Regime and STP work streams (January 2017 – TBC) (Joint Committee – TBC) Princess Alexandra Hospital Mental Health Services for Transformation of Services – Transformation of Services – (Harlow) regulatory concerns - children and young people Sustainability and Transformation Scrutiny of specific work Hertfordshire HOSC (Southend-on-Sea Borough Plans impacting on North East and streams under Sustainability representatives to be invited to Council representatives also on West Essex overall project updates and Transformation Plans for join session (January 2017 – the group) (TBC) Hertfordshire and West Essex TBC) - Colchester/Ipswich (Full HOSC or in Joint hospitals merger Committee – TBC) Obesity Issues in Essex Transformation of Services – Healthwatch Essex work NHS England Specialist Scrutiny Report – Scrutiny of specific work programme updates (quarterly commissioning issues /service Implementation review (March streams under Sustainability Full Committee or briefing) variations (in Full Committee or 2017 - TBC) and Transformation Plans for Joint Committee - TBC as they North East Essex and Suffolk arise) (Joint Committee with Suffolk) East of England Ambulance Consultations on other service Service – regulatory concerns reconfigurations & variations, (Regional HOSC Chairs forum) eligibility & accessibility changes.
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