To: Members of the Scrutiny Committee Professor Steven Broomhead Chief Executive Councillors: Cllr T Higgins - Chair Town Hall Cllr J Guthrie - Deputy Chair Sankey Street Cllrs M Creaghan, G Friend, C Froggatt, Warrington W Johnson, I Marks C Vobe and S Woodyatt WA1 1UH
Co-opted Members:
Statutory Co opted Members Roman Catholic Representative: Mr D Littlewood Church of England Representative: Mr S Harrison Parent Governor Representative: Vacancy Parent Governor Representative: Vacancy
15 July 2014
Meeting of the Scrutiny Committee
Wednesday, 23 July 2014 at 6.30pm
Council Chamber, Town Hall, Sankey Street, Warrington, WA1 1UH
Agenda prepared by Julian Joinson, Principal Democratic Services Officer – Telephone: (01925) 442112 Fax: (01925) 656278 E-mail: [email protected]
A G E N D A
Part 1 Items during the consideration of which the meeting is expected to be open to members of the public (including the press) subject to any statutory right of exclusion.
Item Page Number 1. Apologies for Absence
To record any apologies received.
Item Page Number 2. Code of Conduct - Declarations of Interest Relevant Authorities (Disclosable Pecuniary Interests) Regulations 2012
Members are reminded of their responsibility to declare any disclosable pecuniary or non-pecuniary interest which they have in any item of business on the agenda no later than when the item is reached.
3. Minutes
The Committee is requested to note that the minutes of the special meetings held on 28 April and 3 and 9 July 2014 will be submitted to the meeting on 24 September 2014.
A verbal update will be provide at the meeting regarding the Executive Board’s consideration of the Committee’s recent referrals under the Call-In procedure.
4. North West Ambulance Service - Good to Great: Five Year Business Plan
To consider a presentation from representatives of the North 1 – 8 West Ambulance Service on its Good to Great (G2G): 5 Year Business Plan.
A copy of the G2G Business Plan is attached.
5. Transforming Cancer Care
A presentation will be provided by representatives of the NHS 9 – 106 Cheshire and Merseyside Commissioning Support Unit and Clatterbridge Cancer Centre NHS Foundation Trust, regarding the proposals to transform cancer services in the region.
A letter from NHS England and Clatterbridge Cancer Centre NHS FT, dated 23 May 2014, is attached as Agenda Item 5(A), and includes the following Appendices regarding the (9 – 94) proposals:-
Appendix 1 – Transforming Cancer Care Proposal: May 2014 (11 – 36) Appendix 2 – Communication and Consultation Plan (January (37 – 92) 2014 – September 2014): May 2104 Appendix 1 – Pre-consultation - (51 – 82) Qualitative Analysis Report June 2013 Appendix 2 – Stakeholder Matrix Model (83 – 86) Appendix 3 – Strategic Communication (87 – 92) and Engagement Plan (ii) Appendix 3 – Public Engagement Feedback Document (93 – 94)
The promoters of the proposals (‘responsible persons’) have now commenced the formal consultation process with the overview and scrutiny function of local authorities in Cheshire and Merseyside potentially affected by the changes.
The Committee is reminded that the Council on 9 June 2014 adopted a Protocol for the Establishment of Joint Health Scrutiny Arrangements for Cheshire and Merseyside. The Protocol sets out the procedure to be followed during a statutory health service consultation and is attached at Agenda Item 5(B). (95 – 106)
The Committee is requested to determine whether it views these changes as a substantial development or variation of health service provision. In making this determination the Committee is requested to consider the relevant factors set out at Paragraph 5.2.4 of the Protocol, namely:-
changes in accessibility of services; impact on the wider community and other services; patients affected; methods of service delivery; and potential levels of public interest.
To date, the following authorities have agreed that the proposal is substantial:- Cheshire West and Chester, Halton, St Helens Knowsley and Sefton. Cheshire East has determined that the proposal is not substantial for its residents. The decisions of Liverpool and Wirral are not known at the time of publication of this agenda.
The relevant Regulations require a Joint Health Overview and Scrutiny Committee (HOSC) to be set up by all authorities who agree that the proposals are substantial, in order to receive information about and to comment on the proposals.
The Protocol envisages that each authority delegate to the Joint HOSC, its powers of referral to the Secretary of State. For the avoidance of doubt, the Committee is requested to confirm that it so delegates its powers of referral to the Joint HOSC.
Under the formula for calculating of appointments to the Joint HOSC in the Protocol, the appointment of 2 Labour Members will now be required. In view of the timescales, it is suggested that any nominations proposed by the relevant political group be approved by the Solicitor to the Council and Head of Corporate Governance under delegated powers.
(iii)
Recommendations:-
(1) To determine whether the above changes are a substantial development or variation of health service provision;
(2) To confirm the delegation to the Joint HOSC of the Committee’s powers of referral to the Secretary of State, for all statutory health consultations within the scope of the Protocol;
(3) That the appointment of the Members nominated by the appropriate political group to serve on the Joint HOSC, be delegated to the Solicitor to the Council and Head of Corporate Governance.
6. Work Programme 2014/15
To consider a report on behalf of the Chairman on the Work 107 – 122 Programme 2014/15
7. Date of Next Meeting
To note to the date of the next meeting of Wednesday, 24 September 2014.
Part 2
Items of a "confidential or other special nature" during which it is likely that the meeting will not be open to the public and press as there would be a disclosure of exempt information as defined in Section 100I of the Local Government Act 1972.
Nil
If you would like this information provided in another language or format, including large print, Braille, audio or British Sign Language, please call 01925 443322 or ask at the reception desk in Contact Warrington, Horsemarket Street, Warrington.
(iv) Good2Great The Five Year Business Plan Good2Great - The Five Year Business Plan
“As a Trust, we place patients and staff at the centre of everything we do. We are here to serve the community of the North West of England and provide care to those patients that need us by delivering the right care, at the right time and in the Foreword right place...” In the context of the significant change that the NHS is undertaking currently, it is important that North West Ambulance Service NHS Trust has a clear vision on what we are trying to achieve. More importantly, we need to ensure we have a simple, consistent message driving our behaviours that we are here to do our best for patients in a caring and compassionate manner. I would welcome you taking the opportunity to engage with us and discuss further how the changes outlined can be realised. Bob Williams, Chief Executive Introduction
The North West Ambulance of England and provide care to Just being ‘good’ isn’t good Service (NWAS) NHS Trust is those patients that need us by enough, we believe we should the second largest ambulance delivering the right care, at the strive to be great. To help us service in England, covering a right time and in the right place - achieve this we have consulted total area of 5,400 sq m and either via the physical presence with staff and Trust governors to serving a population of over of an emergency vehicle or by devise a five year business plan seven million people. referral to another health care that will enable NWAS to move provider. from ‘being good to being great’. Formed from the five legacy ambulance services of Cumbria, In all, NWAS is what could be Lancashire, Greater Manchester, considered a successful ‘good’ Cheshire and Merseyside, NWAS Trust with good staff and a has made great strides since its good reputation. Over the last inception in 2006 to establish few years, we have achieved a cohesive, first class urgent, our response time targets, emergency and patient transport balanced our books, had a low service which is responsive to staff turnover, implemented a people’s needs across the North number of new ways of working West. and continued to meet local and national quality standards. It As a Trust, we place patients and would be easy to just stay with staff at the centre of everything this and keep doing it, but that we do. We are here to serve the would be wrong. community of the North West
2 3 Good2Great - The Five Year Business Plan Good2Great - The Five Year Business Plan
Case for Change Future Focus NHS Culture of Caring • Commitment to quality costs and constrained financial As we strive to develop from a for 20, 30 and even 40 years’ The key actions and assurances of care resources, these facts have led good organisation into a great service – which has to count for for achieving this aim are: In the current media climate, • Compassion to the general consensus that organisation, there are three something. it isn’t often we hear the word • Improving lives our current health services are aims which the Trust will aspire • Issues reviewed under a ‘good’ when referring to an NHS • Everyone counts unsustainable. to achieve along that journey: Recently, the Trust has seen principle of learning organisation. It’s probably even national recognition in achieving • Delivering best practice rarer to hear the word ‘great’. It is clear that the NHS needs to the Investors in People Gold education, training and But if the NHS and its staff Economic Climate change and it needs to change Delivering Safe Care award, one of only a handful of equipment weren’t any of these, it wouldn’t The NHS is in the middle of now if we are to meet the Closer to Home organisations to achieve such an • Continually review policies be one of the world’s largest the greatest funding pressure quality and efficiency challenges We know we already have some accolade. We have also become and procedures for best care employers with eight out of ten it has ever had to face in its ahead. Yet, with budget very successful clinical care an Investors in People Champion, British people believing it is one 66 year history. There have constraints getting ever tighter, pathways in place to ensure which means other organisations How Will This Be of the best healthcare providers already been changes to it is also clear that the only way patients get the right treatment are now learning from us. in the world. make savings and improve we can meet those challenges in the right place, but we also Measured? productivity, both centrally and is to rethink how we provide know that there is more to be However, we are not complacent Our success in achieving The publication of the Francis by individual trusts, meaning our existing healthcare services done. Patients, by definition, are - there is always room for these aspirational aims will be Report of the Mid Staffordshire the NHS is on track to find £20 and how and where they are either ill or injured and we need improvement. The Trust is determined by realising the Public Inquiry has highlighted billion of efficiency savings by accessed. We must respond, not to make sure that they receive currently looking at ways in following: the need for organisations to 2015. However, without further just to increasing demand, but the best possible care from us, which it can further help staff create and maintain the right changes to how services are also to cultural change. whether that is face-to-face from feel empowered and supported • Improved/ Increased staff culture to deliver high-quality delivered the high-quality, yet an emergency crew, support from in the decisions they make and and patient satisfaction - care that is responsive to free at the point of use, health Over the course of the past Patient Transport Service staff in give them the confidence to NHS organisations are best patients’ needs and preferences. service we so often take for decade, with advances in being able to attend outpatient make those decisions as well as placed to foster a culture His emphasis on developing the granted will not be available to technology, the NHS has appointments and continue improve engagement and staff of compassionate care right culture of care within the future generations. modernised considerably, but their treatment, helpful advice health and wellbeing. through motivating their NHS, through better leadership, the way we run our lives has from a clinician over the phone teams, creating an open training, information and Each year, the NHS deals with also changed considerably. The or referral to a GP for further The actions we see as key to environment in which transparency is unquestionably 24 million calls to NHS urgent rise of social media, increase in treatment. achieving this aim are: mistakes are learnt from, and the right approach and one and emergency care telephone online transactions and access ensuring that candour 1 which all NHS organisations services and carries out 7 to information at the click of a The ways we are striving to • Organisational culture change permeates from the Board to need to adopt. million emergency ambulance button, means we live in a world achieve this aim are to: • Promote best practice and the frontline. 2 journeys nationally . A demand of rapid knowledge transfer and behaviours • Reductions in accidents and Now more than ever, we need which continues to rise year- rising expectations. NHS trusts • Empower and support staff • Remove historical barriers to injuries to reassure patients that we on-year with the number of need to adapt accordingly; it is to make decisions improvement • Reduction in sickness will listen and respond to their calls received by the ambulance time to do things differently. • Increase integrated working absence and in industrial- concerns, and we need to listen service nationally, over the last with other services Cause No Harm related sickness to staff who see first-hand how decade, rising from 4.9million to • Maximise use of technology • Reduction in serious incidents 3 our procedures and policies over 9 million and emergency as a lever for change Like all other NHS trusts, patient and complaints affect them and those in our admissions to hospitals in and staff safety must be at the • Higher use of alternative care – They are the guiding England rising 31 percent heart of everything we do - The pathways 4 principles of the Trust’s five between 2002/03 to 2012/13. A Great Place to Work public come to us in need and • Benchmark against NHS and year plan to move from ‘being When people join NWAS, they look to us for our help and external companies good to being great’. A strategy Statistics also show that growth tend to stay. Our staff turnover is compassion. Thankfully, a patient which will also ensure that the in demand is set to continue well below the national average coming to harm while under following key elements of an as people live longer with for both ambulance services the care of NWAS is a very rare NHS culture of caring underpins increasingly complex, and often and the NHS as a whole, so we occurrence, but it does happen all that we do: multiple, long-term conditions are well on the way to achieving and, like all other NHS trusts, we and as lifestyle risk factors, such this aim. Each year, we see staff must seek ways to minimise the • Working together for patients as excessive use of alcohol, receiving long service awards risk as much as possible. • Respect and dignity increase. Combined with rising
1, 2, 3, 4, -Ref. Transforming urgent and emergency care services in England, Urgent and Emergency Care Review, End of Phase 1 Report. Urgent and Emergency Care Review Team, 2013
4 5 Good2Great - The Five Year Business Plan
“We believe that by providing a robust urgent care service, supported by NHS 111 and other community Putting Plans into Action services, the extension of clinical referral options and an effective education programme for our paramedic In addition to helping us achieve care pathway from end to end For several years now NWAS our aspirational aims, our if we are to create a service has communicated its desire workforce, we can greatly alleviate pressure on five year strategy to go from that is more responsive and to change the service delivery our 999 service, reduce attendance at Emergency good to great marks a pivotal personalised for patients and model, with a particular Departments and improve efficiencies.” change for the organisation delivers even better clinical emphasis on providing a robust and a fundamental shift in how outcomes. urgent care service for those we deliver our services. Our who call 999 but who do not plans include a number of key The current local and national necessarily need an ambulance developments which are well discussions on the future of or to go to hospital. underway. Urgent and Emergency Care are critical to the position and The objective is to reduce the Changes to Emergency future role of the ambulance numbers of patients who attend service. NWAS is engaged in emergency departments and and Urgent Care the conversations at both levels ensure patients receive the right As highlighted in the Keogh and it is clear that there is the care at the right time and in the review, there needs to be a opportunity and a willingness right place. The reality is that critical change in how and where to make significant change to millions of patients every year we meet the urgent care needs the overall system as well as our seek or receive help for their of people in this country. It is part in it. urgent care needs in hospital essential that we transform the who could have been helped whole urgent and emergency much closer to home.
Emergency Service Delivery Model Through our ongoing initiatives The North West Ambulance paramedic workforce, we can of Hear and Treat, See and Treat Service stepped in as a stability greatly alleviate pressure on our Triage Assess, Treat or Refer Transport and Treat and Convey we can partner for the NHS 111 service 999 service, reduce attendance ensure that those patients who in the North West in October at Emergency Departments Specialist need alternative care pathways 2013 after the previous and improve efficiencies. This can be signposted to them and provider, NHS Direct, withdrew system-wide approach is the Patients dialling On Scene Destination Emergency those who really need to be in from their contract. Since that best way to create a sustainable (999/111) Assessment Ambulance hospital can arrive there in a time, the NWAS NHS 111 service solution and ensure that we timely fashion. Our Red 1 – life- has gone from strength to will be able to continue to Emergency threatening calls only account strength in delivering a reliable provide a rapid, high quality and Department for 38% of our overall activity and efficient service against responsive service which puts Ambulance so we need to effectively a backdrop of negative media patients first. Telephone Emergency respond to the remaining attention nationally and ever Assessment Control patients in a manner which increasing demands on the Achieving Foundation fits their needs and enables service. The service continues Urgent Care emergency ambulances to to perform to a high standard, Trust Status Centre remain available for those who it is fast becoming a vital asset We have submitted our two-year really need them. in the Urgent Care Strategy for and five-year business plans to GP or HCP Non-emergency the North West community and the Trust Development Authority. GP and Requested Ambulance To assist with this, we have we see it as a key part of that With a new Trust Board in place, Healthcare Response invested approximately strategy moving forward. we are continuing to provide Professional Call £500,000 in providing more quality assurance and maintain performance and remain on Safe care appropriate responses to non- We believe that by providing track to reapply for Foundation closer to life-threatening emergencies, a robust urgent care service, Trust (FT) status this summer. home such as our Urgent Care service, supported by NHS 111 and which provides telephone other community services, the Principles of Service Delivery Model Gaining FT status will be a key Hear and Treat: Clinical advice given over the phone. advice and triage and can direct extension of clinical referral See and Treat: Treating patients at the scene. patients to more appropriate options and an effective enabler to the Trust going from Treat and Convey: Conveying patients from the scene to an appropriate care destination. services. education programme for our ‘good to great’. It will provide
6 7 Good2Great - The Five Year Business Plan Good2Great - The Five Year Business Plan
us with greater control over our patients and other stakeholders strong position when it comes practice models to shape shift, this means that the Trust frontline services and to deliver future - we will have greater – improvements which harness to rebidding for the contracts and influence quality based is paying for utilities, rates, cost savings. financial stability with longer advanced technology and have in the future. We will continue capabilities for the public in security, groundskeeping and contracts with our commissioners seen the introduction of a to regularly ask patients for respect of major incidents. maintenance for properties Corporate services are largely which will support longer term number of new initiatives which feedback on their experience which, for a great proportion of efficient and have little scope planning for our future; staff include: of using the service and meet the time, are vacant. for any more department level will benefit from better access with PTS staff to discuss service Cost Improvement cost efficiency savings. But to training and development • Improvements to the online developments and performance Programme – Achieving We have been looking at a there is, however, scope for opportunities through longer booking processes for and ask their opinion on ways Efficiencies range of options which include further efficiency savings and term investment; governors and Healthcare Professionals the service can further improve. NWAS is funded by the British refurbishment, relocation, a ‘hub effectiveness by going to a very members will have a greater say and the introduction of new tax payer and every penny we and spoke’ model (where larger different model of operating in how the Service is run and it Freephone telephone Resilience – Planning spend is accountable. We are strategically placed stations act which could deliver efficient will help us to further strengthen numbers. Expertise a responsible public sector as a base for ambulances which and effective services, achieve our local partnerships, as FTs • A more flexible service with a organisation and, like everyone are then deployed out to areas) cost reductions as well as build As a Category One Responder have a duty in law to work range of transport providers. else in today’s financial climate, and the sharing of facilities with capability and capacity to meet under the Civil Contingencies with local organisations and • Full and consistent use of we have to use our money emergency and NHS colleagues. organisational needs in the Act 2004 (CCA) NWAS has a communities to provide better eligibility criteria to ensure wisely. The Trust has also undertaken a future. These include: services for patients. those who need the service vital role to perform in respect review of its corporate services of developing, maintaining have access to it, together The Trust needs to save £48.6m and last year we appointed • A focus on structure, people, and delivering civil protection Maintaining Delivery with signposting information over the next four years and has Deliotte to carry out the review. technology and processes duties to the public. In addition to transport solutions for a number of initiatives in place The review identified that to create a modern and of Patient Transport to the CCA, the NHS Emergency those who do not meet the to help achieve this. We know savings could be achieved sustainable corporate Service Contract Preparedness, Resilience and criteria. by introducing the planned through short-term efficiency services to enable the Trust Response (NHS EPRR) Framework Standards • Text message booking changes to our emergency and gains by improving staff to meet statutory obligations, sets out the standards expected Since 1 April 2013, NWAS reminders to patients/carers urgent care service, we will be productivity, creating a leaner day-to-day operational of the NHS to ensure suitable has been the provider of • Use of mobile data systems able reduce the need for more staff profile, minimising the use needs and wider strategic arrangements and capabilities non-emergency ambulance to ensure availability of emergency ambulances in some of agency staff and lowering and development priorities. are in place to deal with major transport in the four counties of information on patient areas and at times of low activity non-pay costs. • Corporate services to be incidents and events, whatever Lancashire, Cumbria, Cheshire progress times which, in the longer term, will organised into four the cause is, and be able to and Merseyside. Won under • An improved service for go some way to achieving the Following the review, the Trust tiers around: self-service, respond and recover from the commercially competitive haemodialysis and cancer savings we are required to Board cited that £4.38m of the transactional processing; consequences. This includes the conditions, the current contract patients - e.g. transport will make as part of our cost Trust-wide cost-savings to be professional centres of ability to ensure the business runs for three years and will be be provided for improvement plan. achieved by 2016/17 should be excellence and strategy, to continuity of essential services going back out to tender in 2016. haemodialysis appointments delivered through a reduction of help embed strategic is delivered during disruptive up until 19:30hrs and We can also make significant 20% of corporate staffing costs planning. challenges. The contract focusses on collection until 01:00hrs. savings without affecting and non-pay costs. • Improving staff productivity the quality of service for all patient care, by reviewing our The Trust has an extremely patients - an enhanced patient As part of the Trust’s continued property portfolio for example. As such, all directors have This transformation of our well recognised Resilience experience, delivered through effort to improve a patient’s In December 2012, we launched been tasked to examine their corporate services will be team capability that is highly increased quality standards, experience, we also have a our Estates Review - an team portfolios to see where carried out in full consultation respected as leaders on particularly around the journey PTS Patient Charter in place, extensive project involving all efficiencies can be made. As part with staff. It has been a national basis. Through waiting and collection times and which explains the rights and Trust stations throughout the of this, the Executive team has agreed to undertake a staged this Team, we are able to the provision of a flexible service responsibilities of service users region and our corporate sites. been reduced from seven to five approach to implementing the demonstrate that we work that meets the needs of patients. and have introduced a handy and, it is likely that we will see a recommendations of the review intrinsically with all multi- Patient Information Card which Many Trust stations have been in reduction in the number of posts with the anticipation that the agency partners in developing The quality and performance explains the level of service operation since the 1960s and within our corporate teams. recommendations will be fully contingency plans and of our Patient Transport Service a patient can expect, useful since then, have been enveloped implemented by 2016/17. capabilities to deal with the risks, (PTS) is closely monitored and, contact numbers and a step-by- by new road infrastructure, Implementing the hazards and threats identified over the past year, we have step guide to their PTS journey. developments and increased under the CCA programmes. Corporate Services seen significant improvements traffic. Some are also in a poor Review in performance against the We believe that continual state of repair. Our entire estates NWAS remains committed to contracted quality standards. engagement, both with patients portfolio costs approximately The corporate services working to improve the NHS This is due to a number of and staff, is key to ensuring PTS £1.8m to maintain. Considering review is being undertaken to and multi-agency response quality improvements which quality standards are maintained that ambulances are on the effectively meet the needs of arrangements, using exercises, have been built into the service and improved upon which road for the majority of their the organisation, particularly lessons identified and best as a result of feedback from will enable the Trust to be in a
8 9 Good2Great - The Five Year Business Plan
“All NWAS staff, partner organisations, patients and external stakeholders have a part to play in What Will This Mean For You? helping to implement and support the changes that Going from ‘good to great’ and which is robust, fit-for-purpose a part to play in helping to lie ahead... by working closely together, we will be implementing our five year plan and responsive to the needs of implement and support the able to realise our aims.” is no small feat and there will the people of the North West. changes that lie ahead and we be challenges along the way, are confident that, by working but these changes are essential All NWAS staff, partner closely together, we will be able if we are to continue to be a organisations, patients and to realise our aims. financially viable, quality service external stakeholders have Message from the Trust Chair and Chief Executive
Mary Whyham, Chair Bob Williams, Chief Executive
Thank you for taking the time to five year plan, we have made microsite to keep you up-to- read this document and learn a commitment to keep you date on key developments more about our plans to go informed and listen to your and allow you to submit any from good to great. The Trust views. comments, questions or queries prides itself on being an open you may have on the planned and honest organisation and the In addition to a programme developments. Please visit: views of all our stakeholders of meetings with staff, MPs, www.goodtogreat.nwas.nhs.uk – staff, members, health and healthcare and patient or email your query to: social care partners – are very representative groups across [email protected] important to us. Throughout the North West, we have created the implementation of our a dedicated Good to Great
10 11 Your opinions are important to us. If you have any views about this Good2Great document or if you would like to receive this document in large print, braille, on audio tape, or in an alternative language, please contact us.
Trust Headquarters Ladybridge Hall, Chorley New Road, Bolton, BL1 5DD
Tel: 0845 112 0 999 (local rate) Minicom: 0151 260 8628 Email: [email protected] Website: www.nwas.nhs.uk
Like us at: Follow us at: /nwasofficial @NWAmbulance
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23rd May 2014
Councillor Tony Higgins Chair Scrutiny Committee Warrington Borough Council 27 Dove Close Birchwood Warrington WA3 6QH
Dear Councillor Higgins
Re: Arrangements for Overview and Scrutiny consultation on proposed changes to provision of services by The Clatterbridge Cancer Centre NHS Foundation Trust
In line with the Health and Social Care Act 2012 and the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations regarding health scrutiny we are writing to inform you that we are planning a formal public consultation on proposed changes to services provided by The Clatterbridge Cancer Centre NHS Foundation Trust and to request consultation with the Health Overview and Scrutiny Committee regarding the planned changes.
Collectively, we believe this may be a substantial variation in the provision of cancer care for people in your area. We plan to carry out a formal 12-week public consultation on the proposals in summer 2014, which as you may recall we highlighted in previous correspondence in late 2013/early 2014. A summary of our pre- consultation is appended to the 2014 Consultation Plan (enclosure 2).
We are seeking your consideration under the revised statutory framework which authorises local authorities to:
• Review and scrutinise any matter relating to the planning, provision and operation of the health service; and, • Consider consultations by a relevant NHS body or provider of NHS-funded services on any proposal for a substantial development or variation to the health service in the local authority’s area.
As accountable commissioners (NHS England Cheshire, Warrington and Wirral Area Team Specialised Commissioning) and the provider (The Clatterbridge Cancer Centre NHS Foundation Trust) of the services affected by these proposals, we are asking each local authority to individually reach a view on whether they are satisfied that this proposal is deemed to be a substantial development or variation and that it impacts on the health services in your area. This proposal affects all local authorities across Cheshire and Merseyside, namely;
• Cheshire East Council • Cheshire West and Chester Council • Halton Borough Council • Knowsley Council • Liverpool City Council • St Helen’s Metropolitan Borough Council • Sefton Council • Warrington Borough Council • Wirral Borough Council
The Clatterbridge Cancer Centre has sent details of feedback following the pre-consultation phase to each local authority’s Health Overview and Scrutiny Committees/Panels and has attended several local authority committees this year to feedback our insight following the pre-consultation period.
NHS England Area Team specialist commissioning and The Clatterbridge Cancer Centre would ask that where more than one local authority agrees this proposal to be a substantial variation, that a joint Overview and Scrutiny Committee is formed for the purpose of considering The Clatterbridge Cancer Centre NHS Foundation Trust proposal for change collectively.
During our feedback to local authorities, we have informed local scrutiny officers of our intentions and we are aware that a protocol for the establishment of a joint Health Scrutiny arrangement for Cheshire and Merseyside areas has been under discussion.
In making this request we would like to confirm the following details to support your decision making process.
• As the accountable commissioner and provider, we would need your response and comments to the proposal by 7 November 2014.
• The Clatterbridge Cancer Centre NHS Foundation Trust intends to make its final decision (subject to NHS England and Monitor approval) whether to implement the proposal by 30 January 2015.
• The Clatterbridge Cancer Centre NHS Foundation Trust will be publishing these dates and all consultation documentation by 1 July 2014.
• If these dates alter The Clatterbridge Cancer Centre NHS Foundation Trust will inform the local authorities and update our publication materials accordingly.
NHS England will also be undertaking its own assurance process of the proposals and this process should be completed by the end of June 2014. A copy of the report will be provided in due course.
Further information about the case for change and the service changes proposed in response to this is enclosed, together with our detailed consultation plan. We would of course be happy to provide any further detail or clarification that you would find helpful.
Please do not hesitate to contact us if you would like further information or have any questions.
Yours sincerely,
Alison Tonge Andrew Cannell Interim Area Director Chief Executive Cheshire, Warrington and Wirral The Clatterbridge Cancer Centre Area Team NHS Foundation Trust NHS England
Enclosures
1. Case for Change 2. 2014 Consultation Plan
TRANSFORMING CANCER CARE
AN OPPORTUNITY TO SIGNIFICANTLY IMPROVE THE DELIVERY OF CANCER SERVICES ACROSS THE MERSEYSIDE AND CHESHIRE CANCER NETWORK
May 2014
Contents
Section Page No. 1. Introduction 3
2. The Catchment Population served by The Clatterbridge Cancer 4 Centre
3. Cancer incidence & mortality across the Merseyside & Cheshire 5 Cancer Network (MCCN)
4. Current configuration of cancer services provided by CCC across 9 the MCCN
5. Proposals to transform cancer services in Merseyside & Cheshire – 10 The Case for Change
6. The current Strategic Environment 12
7. Outcome of the Pre-Consultation Engagement Work undertaken 14 over the Winter of 2012 / 13
8. The proposed changes in cancer services as a consequence of the 16 Transforming Cancer Care Project
9. Benefits which would be delivered by the Proposed Changes 19
10. Impact on patients as a consequence of their place of treatment 21
11. Timescales 26
12. Stakeholders involvement 26
13. Summary 26
1. INTRODUCTION
The Clatterbridge Cancer Centre NHS Foundation Trust (CCC) is a highly regarded specialist cancer Trust providing non-surgical treatment for patients suffering from solid tumour cancers within the Merseyside and Cheshire Cancer Network (MCCN).
This document has been produced by CCC, supported by Cheshire, Warrington and Wirral Area Team, its commissioner of services. The document describes the background to the Transforming Cancer Care project, the proposals for change and expansion of the CCC services, and both the clinical rationale for these changes and the benefits which will result from them.
2. THE CATCHMENT POPULATION SERVED BY THE CLATTERBRIDGE CANCER CENTRE
The Trust serves a population of around 2.3 million with the majority of patients drawn from the areas shown in Table 1 below:
Table 1: Population served by CCC shown by Clinical Commissioning Group1 Clinical commissioning group Population % of total
South Cheshire 175,943 8 Vale Royal 102,144 5 Warrington 202,709 9 West Cheshire 227,382 10 Wirral 319,837 14 Halton 125,722 6 Knowsley 145,903 7 Liverpool 465,656 21 South Sefton 159,764 7 Southport and Formby 114,205 5 St Helen’s 175,405 8 Total 2,214,670 1. ONS ‐ mid 2011 population by CCG ‐ includes people under 16y.
From the above it can be seen that around 67% of the catchment population for the CCC live north of the River Mersey. The current CCC site at Bebington is therefore neither central to its geographical catchment nor close to its centre of population density.
3. CANCER INCIDENCE AND MORTALITY ACROSS THE MERSEYSIDE AND CHESHIRE CANCER NETWORK (MCCN)
The incidence (new cases) of and mortality (death rates) from cancer represent a major challenge within Merseyside and Cheshire. The incidence and mortality rates for each Primary Care Trust (PCT), the most recent ‘units’ for which this data is available, are shown in Figure 1 and Figure 2 below in comparison with the rate for England as a whole.
Figure 1: Incidence of all cancers across the MCCN, compared with the average for England.
1. Age standardised ratio
Figure 2: Death rates from all cancers across the MCCN, compared with the average for England.
From the above figures it can be seen that the both the incidence of cancer, and deaths from cancer are higher across almost all areas compared to the England average, with Liverpool and Knowsley particularly badly affected.
Breast, lung, colorectal, prostate and upper gastro-intestinal (GI) cancers account for over 90% of all new cases of cancer and over 75% of cancer deaths, both nationally and across the cluster.
The incidence of breast cancer is generally above the national average across the network, as are deaths due to breast cancer.
The incidence of new cases of lung cancer across the cluster is higher than the national average and almost twice the national rate in Liverpool and Knowsley. Similarly, lung cancer mortality rates across the cluster are higher than the national average and almost twice the national rate in Liverpool and Knowsley.
The incidence of new cases of colorectal cancer and colorectal cancer mortality rates are higher across the cluster than the national average.
The incidence of new cases of prostate cancer across the cluster is lower than the national average except for Wirral and West Cheshire; however deaths as a result of prostate cancer are higher than the national average in a number of areas, particularly Sefton and Wirral.
The incidence of new cases of upper GI cancer across the cluster is higher than the national average. Similarly, upper GI cancer mortality rates across the cluster are higher than the national average.
The incidence of, and deaths from the common cancers are shown in Figures 3 and 4 below, in comparison with the England average.
Figure 3: Incidence of the common cancers across the MCCN network, compared with the average for England.
Figure 4: Death rates from the common cancers across the MCCN, compared with the average for England.
By comparing the mortality rate for each PCT with the average for England, the number of cancer deaths above the national average can be determined. This is the number of lives that could be saved each year if the mortality rate across the network was the same as the average in England. This equates to 589 deaths each year as shown in Table 2 below.
Table 2: Comparison of excess deaths from cancer across the cancer network. Excess deaths per year in comparison with England PCT average*
Liverpool 316 Halton & St Helen’s 97 Wirral 77 Knowsley 64 Sefton 35 Warrington 0 West Cheshire -4 South Cheshire -8 Total each year 589 * 2008-2010 National Cancer Intelligence Network (NCIN) data
Cancer is now the biggest single cause of death in Cheshire and Merseyside.
4. CURRENT CONFIGURATION OF CANCER SERVICES PROVIDED BY CCC ACROSS THE MCCN
CCC operates a networked cancer service across the whole of the MCCN. The current configuration of CCC cancer services is shown in Table 3 below.
Table 3: Current geographical distribution of CCC clinical services Site Inpatient TYA Chemo R’therapy R’therapy Acute Out beds daycase treatment planning Oncology patients CCC – Clatterbridge Y Y Y Y Y Y Y CCC - Aintree - - - Y - - Y Aintree University - - Y - Y Y Hospital The Walton Centre ------Y Royal Liverpool University - - Y - - Y Y Hospital St Helen’s & Knowsley - - Y - - Y Y Hospitals Warrington & Halton Hospitals - - Y - - Y Y Arrowe Park Hospital - - - - - Y Y Alder Hey Children’s ------Y Hospital Liverpool Women’s - - Y - - - Y Hospital Liverpool Heart and Chest - - Y - - - Y Hospital Southport Hospital - - Y - - Y Y Countess of Chester Hospital - - Y - - Y Y
From the above it can be seen that the CCC’s principal site currently is the Cancer Centre located on the Clatterbridge Health Park at Bebington on the Wirral. The only other site currently providing radiotherapy is CCC’s satellite unit at Aintree hospital.
CCC also operates an extensive network of chemotherapy clinics and outpatient clinics in partner NHS Trusts across the MCCN, as well as an acute oncology service, supporting partner Trusts in the care of cancer patients who have been admitted to these hospitals.
5. PROPOSALS TO TRANSFORM CANCER SERVICES IN MERSEYSIDE AND CHESHIRE – THE CASE FOR CHANGE
In 2008 the Merseyside and Cheshire Cancer Network (MCCN) commissioned an expert review of the configuration of Cancer Services across the area with the aim of developing recommendations to ensure that services were delivered in the best way to improve outcomes for patients. The resulting report ‘The organisation and delivery of non-surgical oncology services in the Merseyside and Cheshire Cancer Network’1 was presented to the local Cancer Taskforce in October 2008.
The report identified a number of reasons for considering a change in the service model location and delivery of non-surgical oncology in the MCCN area including:
Encouraging the major expansion of radiotherapy through the development of satellite radiotherapy units closer to the populations served and limiting the size of major centres to a maximum of eight Linear Accelerators. The decentralisation of chemotherapy which requires a larger clinical workforce with a greater local presence. More flexible service delivery models required which were less dependent on a single centre and more served through networks of care. The increasing use of multi-modality treatment regimes suggesting that, in the longer term, isolated oncology centres were no longer appropriate. The organisation of hospital services in MCCN meant that integrated cancer care was dependent on oncologists to secure the integrity of patient pathways. It was more difficult to achieve this from a remote centre. The needs of the network population were high in terms of cancer care but the results were likely to be inhibited by poor accessibility to oncology services as well as by late presentation. Closer alignment of oncologists to local general hospitals would shift the balance of leadership in cancer care and would support improving the overall organisation and delivery of care. Developing cancer research in Liverpool, an essential component of all cancer care and of medical research, was compromised by the absence of academic oncology leadership. The isolation of the current cancer centre and its distance from surgical oncology and Specialist Multi-Disciplinary Teams were factors in the difficulty in addressing this deficiency.
Consequent on these findings, a number of immediate steps were taken which included:
the enhancement of clinical services at CCC to increase the Trust’s ability to care for very acutely ill patients the opening of the satellite radiotherapy unit at Aintree the establishment of a number of Chairs in a variety of cancer-related fields, in partnership with the University of Liverpool The establishment of an acute oncology service in partner trusts
1 ”The organisation and delivery of non-surgical oncology services in the Merseyside and Cheshire Cancer Network” A feasibility study into the potential relocation of non-surgical oncology services from Clatterbridge to Liverpool (October 2008) Prof. M R Baker and Mr R C Cannon
However more still needs to be changed in order to fully address the points identified by Baker and Cannon and ensure that all local people are able to receive the highest quality care available and to benefit from the best possible clinical outcomes.
First and foremost is the issue of the geographical location of the specialist Cancer Centre on the Clatterbridge hospital site. In their report Baker and Cannon confirmed that:
“When it was first established, the Clatterbridge campus provided a wide range of medical and surgical services; this is no longer the case and the oncology facilities are now isolated from modern medical and surgical practice. During this time, the complexity of cancer treatments has increased dramatically, patients are older and sicker and the treatments have more side effects. In most cancer centres, most of the beds are used for patients who are seriously ill because of their underlying cancer or because of the side effects of treatment. The management of these conditions requires ready access to both critical care facilities and the on-site access to the full range of general medical and surgical expertise. This is no longer possible at Clatterbridge.”
Following the acceptance of the recommendation contained within the Baker Cannon report in 2009, the then Merseyside Cluster Board commissioned PricewaterhouseCoopers to undertake a high-level feasibility study on the establishment of a new acute cancer centre in Liverpool. The findings of this study were presented to Merseyside Cluster Board by Liverpool PCT; as a consequence of this approval was given to allocate funding for project costs to deliver a business case for the creation of a new cancer centre in Liverpool, together with a capital allocation towards the cost of its construction. At the same meeting the need was identified for further recurring funding to be set aside to support the project, delivered through annual commissioning arrangements.
The Transforming Cancer Care project was therefore established by CCC following this network-wide agreement to implement the recommendations of the Baker Cannon report, the most material of which is the development of a new Cancer Centre in Liverpool adjacent to the redeveloped Royal Liverpool University Hospital.
6. THE CURRENT STRATEGIC ENVIRONMENT
Since the Baker Cannon report was published, the conclusions contained within this have been reinforced by a number of strategic, policy and operational factors. These include:
An increase in the number of acutely-ill CCC inpatients who have needed to be moved in order to access specialist opinion or facilities not available on the CCC site. These transfers have grown from 53 in 2011 to 67 in 2013 and in the majority of cases patients were receiving radiotherapy or chemotherapy which had to be interrupted because of their transfer. This is clearly not ideal in a modern healthcare system. The recognition that organisational isolation is a risk factor in the delivery of sub-optimal care (Prof Sir Bruce Keogh: Review into the quality of care and treatment provided by 14 hospital trusts in England). Although there is ample evidence which demonstrates that the care delivered at CCC is very good, the acknowledgement of this risk factor is consistent with the findings of Baker and Cannon. The increasing acknowledgement of the importance of clinical research in the delivery of cancer care. ‘Equity and excellence: Liberating the NHS’, produced by the Department of Health, notes that organisations with strong participation in research tend to have better outcomes, and that research-active organisations are therefore able to offer increased patient benefits both through a direct contribution to knowledge and through enhanced organisational performance. The same document noted that “a thriving life sciences industry is critical to the ability of the NHS to deliver world-class health outcomes. The Department will continue to promote the role of Biomedical Research Centres and Units, Academic Health Science Centres and Collaborations for Leadership in Applied Health Research and Care, to develop research and to unlock synergies between research, education and patient care”.
The investment proposal is supported by the Trust’s commissioner of clinical services, Cheshire, Warrington and Wirral Area Team, as well as by the Merseyside Area Team and by local CCGs, who do not directly commission specialist cancer services but nonetheless have a very strong interest in the delivery of high quality cancer care to their respective populations. The project also has the strong support of clinicians within CCC, as well as those with a cancer interest across the MCCN. The project is consistent with the strategic plans for the delivery of clinical and other services across Merseyside and Cheshire. In particular it supports Liverpool City Council’s vision for the future of the city region which sees healthcare and life sciences research as a core component in the ongoing development of the city (Liverpool City Region’s knowledge economy: delivering new opportunities for growth).
The project also sits alongside Liverpool CCG’s Healthy Liverpool Programme which has been set up to help the CCG adapt to face future challenges, such as an ageing population and increase in long-term conditions, while also improving the health of residents. Although the location of some services may change as a result of this Programme it is clearly understood that the Royal Liverpool University Hospital will remain a hub for delivery of acute services to the population of Liverpool and, as such, will provide the type of services which will complement the cancer services which are planned to be delivered by CCC on the Royal Liverpool campus.
The retention of a full range of cancer outpatient services at the existing Clatterbridge site is also supportive of Wirral Council’s vision for retention and potential development of the Health Park at Bebington. As CCC further develops its own strategic plans there will be opportunities to work closely with partners in Wirral to explore ways in which to maximise the role of CCC on this site.
7. OUTCOME OF THE PRE-CONSULTATION ENGAGEMENT WORK UNDERTAKEN OVER THE WINTER OF 2012/13
A wide ranging pre-consultation exercise was held over the winter of 2012/13 to understand the views of the public on the central proposal within the Transforming Cancer Care project – the opening of a new Cancer Centre in Liverpool. This exercise reached over 90,000 people through 114 roadshows and 96 group sessions, and involved 7 District General Hospitals and 12 Primary Care Trusts. Every Healthwatch and a wide range of Cancer Support Groups were also part of this process. 14,500 people visited the roadshows and 4,164 formal written responses were received.
People were asked a Principal Consultation Question (PCQ):
“After finding out about the plans to develop a new Clatterbridge Cancer Centre for Cheshire and Merseyside, which would be based next to the Royal Liverpool University Hospital, do you think this is a good idea?”
Respondents could either answer yes, no or not sure. Respondents were then asked to provide comments about their chosen answer (“why do you think this?”). Overall, the results were as follows:
Yes – 82.63% No – 12.70% Not sure – 4.66%
This showed overall strong support for the proposal. However further analysis of the responses by postcode showed significant differences in view, with the greatest number of people answering ‘no’ or ‘not sure’ appearing in the CH postcode areas i.e. those areas closest to the existing CCC site. When only answers from the CH areas the results were as follows:
Yes – 40.53% No – 49.75% Not sure – 9.72%
When people explained their view by answering the follow-up question ‘why do you think this?’ there were similar themes regardless of whether they thought the proposal was a good idea. The main areas highlighted are shown below:
Accessibility Cost Good current services Ill health (and the impact on ability to travel) Loss of services (from the current location) Travel Visits
In a number of these areas some people saw advantages whilst others saw disadvantages in the proposal. For example, those living in the Liverpool area were likely to comment on a beneficial impact for service accessibility whilst those living on the Wirral were likely to cite adverse impact on accessibility.
The information received from the pre-consultation engagement work has already had an impact upon the Transforming Cancer Care project. In particular it has:
Emphasised strongly the importance placed by patients on access to sufficient, convenient and free car parking when attending for treatment. Highlighted the value placed by patients on the existing organisational culture and values of CCC, and identified the need for the Trust to ensure that this organisational culture is extended to the operation of the new Cancer Centre in Liverpool. Endorsed the overall direction of travel through the strong support given by the public to the consultation question.
The pubic consultation planned to run over the summer of 2014 will be used to gain more information on these issues identified as significant as a result of the pre- consultation engagement work.
8. THE PROPOSED CHANGES IN CANCER SERVICES AS A CONSEQUENCE OF THE TRANSFORMING CANCER CARE PROJECT
In their work to look at options for the future location of the Cancer Centre to address the issues above, Baker and Cannon looked at a long list of nine options which were assessed against ten criteria. The preferred option identified as a result of this appraisal process was the establishment of a new Cancer Centre adjacent to the Royal Liverpool University Hospital.
This new Cancer Centre would provide all inpatient oncology beds for the Cancer network, together with outpatient oncology services for those patients for whom the Liverpool site is the most accessible. The new Cancer Centre would operate as the hub, supporting a network of cancer services which would include the satellite radiotherapy centre at Aintree, the existing Cancer Centre at Clatterbridge which would continue to deliver outpatient cancer care to its local population on the Wirral and in West Cheshire, and the distributed network of CCC outpatient and chemotherapy clinics operated in partner hospitals throughout the MCCN.
This preferred option was considered and supported by the Cancer Taskforce, which included representatives from the MCCN, Trusts and PCTs across the network.
It is this preferred option which the Transforming Cancer Care project now aims to take forwards.
The consequences of this can be summarised in Table 4 below:
Table 4: Current (C) and proposed (P) geographical distribution of CCC clinical services with changes highlighted+ Site Inpatient TYA Chemo R’therapy R’therapy Acute Out beds daycase treatment planning Oncology patients
New Cancer ______Centre – L’pool P P P P P P P CCC – C C C C C C C Clatterbridge - - P P P P P CCC - Aintree - - - C - - C - - - P - - P Aintree University - - C - - C C Hospital - - P - - P P
The Walton ------C Centre ------P Royal Liverpool University - - C - - C C Hospital (provided (provided instead instead - - in new - - P in new CCC on CCC on site) site) Arrowe Park - - - - - C C
Hospital - - - - - P P St Helen’s & Knowsley - - C - - C C Hospitals - - P - - P P Warrington & Halton - - C - - C C Hospitals - - P - - P P Alder Hey Children’s ------C Hospital ------P Liverpool Women’s - - C - - - C Hospital - - P - - - P Liverpool Heart and Chest - - C - - - C Hospital - - P - - - P
Southport - - C - - C C Hospital - - P - - P P Countess of Chester - - C - - C C Hospital - - P - - P P
To summarise the above table, the key proposed changes would be:
The creation of a new Cancer Centre on the Royal Liverpool campus, bringing together inpatient cancer services with critical care, other support facilities and a wide range of medical and surgical experts. The relocation of all CCC’s cancer inpatient beds from the Wirral to Liverpool. The relocation of the Teenage and Young Adult Unit (including their inpatient beds) from the Wirral to Liverpool. The establishment of a new radiotherapy service in Liverpool and an overall increase in radiotherapy capacity. The relocation of complex outpatient radiotherapy from the Wirral to Liverpool, representing about 6% of treatments given. An increase in the capacity of chemotherapy and outpatient services in Liverpool.
The things that would stay the same would be:
The continuation of the existing Cancer Centre on the Wirral as an important site for the delivery of cancer services. Retention of an outpatient radiotherapy service on the Wirral for treatment of the common cancers, which comprise around 94% of treatments given. Retention of a chemotherapy and outpatient service on the Wirral. The services delivered at the Aintree radiotherapy satellite centre. The services delivered by CCC in other hospitals across the cancer network. The national eye proton therapy service, based at the existing CCC site at Bebington.
9. BENEFITS WHICH WOULD BE DELIVERED BY THE PROPOSED CHANGES
When the establishment of a new Cancer Centre in Liverpool was first proposed in 2008 it was noted that such a centre would enable the benefits described below:
Benefits expected as a result of a new Cancer Centre in Liverpool
Better co-ordination of pathways of care for cancer patients by bringing together key specialist services on a single health campus which currently hosts the majority of Specialist Cancer Multi-Disciplinary Teams which are central to the delivery of high quality cancer care.
Improved access for CCC inpatients to specialists from other clinical disciplines and to specialist clinical facilities eg intensive care, which cannot be provided in the existing Cancer Centre.
Delivery of cancer treatments nearer to home for the majority of patients.
Location of the Teenage and Young Adult Unit closer to both the Royal Liverpool
University Hospital and Alder Hey Children’s Hospital and closer to the majority
of the population served, improving patient access and choice.
Closer integration between the NHS and research teams within the University of
Liverpool and other key research partners in the public and private sector.
An increase in patients who benefit because they are able to take part in clinical trials.
Location of specialist services in a place more easily accessible to the majority of patients so that more patients can benefit from improved access, particularly those who need repeated and regular radiotherapy for certain types of cancer and for palliation.
Best use of NHS resources by enabling clinical teams to work more effectively and efficiently together.
Establishment of a focus for innovation and knowledge, complementing and amplifying the efforts of all partners including local employers and councils to promote the region as a premier choice for investment.
Maintenance of those NHS services which are best delivered in more local settings, including district general hospitals and the community.
The development of the new Cancer Centre in Liverpool would bring the inpatient facilities for radiotherapy and chemotherapy onto a single large acute teaching hospital campus adjacent to both university and private sector research partners.
This would give the people of Merseyside and Cheshire, an area with some of the very poorest cancer outcomes in the country, access to the same sort of comprehensive cancer facilities as are already available in other major cities across the UK such as London, Manchester and Birmingham.
The above reasons together form the clinical benefits arising from the changes proposed by the Transforming Cancer Care project.
The National Clinical Advisory Team, who until April 2014 were responsible for reviewing the clinical justification for any proposed service change, assessed the Strategic Outline Case which had been prepared by the CCC as a first step in implementing the recommendations of the Baker Cannon review. This report unequivocally supports the establishment of a new Cancer Centre in Liverpool in order to deliver the benefits described.
10. IMPACT ON PATIENTS AS A CONSEQUENCE OF THEIR PLACE OF TREATMENT
General accessibility The existing Cancer Centre at Bebington is not well served by public transport – the new Cancer Centre in Liverpool would be much more accessible by both bus and train because of its City Centre location. From an analysis of travel times it can be shown that when using public transport, a number of areas which are geographically closer to the Bebington site are closer from a time and convenience perspective to the proposed site in Liverpool.
An Equality Impact Assessment of the proposed changes which was undertaken by Liverpool John Moores University in March 2013 drew the following conclusions:
There are a number of areas geographically close to the Bebington site where travel time by public transport is over an hour. The rail network that links the Wirral and Liverpool works in the favour of those Wirral residents travelling to the Royal Liverpool over those Liverpool- side residents travelling to Bebington. Patients from Sefton, Western Cheshire, Knowsley, St Helen’s and Halton can expect in most cases to travel for more than an hour to reach either site, although a good proportion of these patients might be able to reach the Royal Liverpool site within 45 to 60 minutes, whereas it is unlikely that any of these patients could reach the Bebington site in under an hour.
Public transport links are important since access to private transport, as shown by car ownership, is much less across Merseyside than in other parts of the Cancer Network. This is shown in Table 5 below:
Table 5: Car ownership and percentage of households with a car or van (RAC Foundation, based on 2011 census data) Rank Cars/vans per 1000 % households with Local Authority (out of 348) people car/van Cheshire East 76 606 83.9 Cheshire West 135 572 81.4 Warrington 164 546 80.7 St Helen’s 240 482 73.3 Wirral 250 476 72 Halton 254 469 73 Sefton 261 462 71.5 Knowsley 315 378 62.9 Liverpool 327 323 53.9
Although it is hoped that public transport would be used to attend the new Cancer Centre in Liverpool it is recognised that many people would still prefer to use private transport. Good car parking is very important for cancer patients and so dedicated free parking would be provided for cancer patients attending the new Cancer Centre in Liverpool, and would continue to be provided at the existing Clatterbridge sites on the Wirral and at Aintree.
Patients who are eligible for Ambulance Transport would continue to have this provided, irrespective of the site attended. In 2013 patient attendances by ambulance at the existing Cancer Centre at Bebington were as shown in Table 6 below:
Table 6: Ambulance attendances at Clatterbridge by principal PCT Individual planned patient attendances by PCT ambulance Liverpool 5828 Halton & St Helen’s 4159 Wirral 2154 Knowsley 1922 Sefton 4055 Warrington 2037 West Cheshire 1641 Central & E Cheshire 391
The establishment of a cancer centre in Liverpool is expected to have a beneficial impact on ambulance services since there would be an overall reduction in patient travel times as a result of the opening of a centre in Liverpool.
Inpatient services (including TYA) The proposed changes mean that those patients living in West Cheshire and on the Wirral who need to be admitted to an inpatient bed are likely to travel further for their care, as will their visitors. However these are the patients who are the most unwell or who have the most complex needs, and it is these patients whose treatment would benefit most from being admitted to a Cancer Centre which can draw on the facilities and expertise which is only available in a large acute hospital such as the Royal Liverpool.
In practice the greatest impact of this relocation of inpatient services would be on visitor travel time, and so the consultation planned over the summer will aim to explore this in more detail with a view to understanding how the impact of this might be ameliorated. It should also be acknowledged that there would be a beneficial impact on a greater number of people who currently have to travel from Merseyside to the Wirral in order to visit their relatives admitted to the current cancer centre as an inpatient, and who are less likely to have access to a car or to convenient public transport links.
Patients from Wirral and West Cheshire who may currently be admitted to Clatterbridge but who are not receiving chemotherapy or radiotherapy as part of their inpatient care may well in the future be admitted instead to Arrowe Park or the Countess of Chester under the care of the acute oncology team there, meaning that travel time for them, together with their friends and family would be largely unchanged.
The forecast numbers of inpatients by area who would in future be admitted to Liverpool is shown in Figure 5 below (based on a 2018/19 activity forecast)
Figure 5: 2018/19 forecast inpatient numbers by area admitted to the new Cancer Centre in Liverpool for active chemotherapy or radiotherapy treatment
The above figures show the number of forecast inpatient admissions by PCT for patients who need to be admitted in order for them to receive radiotherapy and/or chemotherapy. They exclude any patients who may need to be admitted to a hospital in order to help deal with the side-effects of their cancer but who are not part-way through a course of radiotherapy or chemotherapy.
Those excluded are the ‘acute oncology’ patients, who at present are usually admitted to their local District General Hospital under the care of the onsite medical team, supported by the local CCC acute oncology service; however, a proportion are admitted to CCC, either directly from clinic or because Clatterbridge is local to them. Work is currently underway to examine the patient pathways for these patients and determine where best they would be cared for in future.
Radiotherapy services The significant majority of patients from Wirral and West Cheshire receiving radiotherapy services on an outpatient basis would continue to attend the existing Bebington site. However a small number of Wirral and West Cheshire patients, specifically those suffering from the less common cancers, would need to travel to Liverpool for their outpatient radiotherapy treatment. Conversely patients from Merseyside, many of whom currently travel to Bebington, would receive their treatment closer to home. The forecast impact of this on patient numbers, based on activity modelling which has been undertaken to support the Outline Business case, is shown in Table 7 below:
Table 7: Current and forecast place of treatment for radiotherapy patients by PCT (by attendances)+
Bebington New Cancer Centre in Aintree Liverpool PCT 12/13 % 18/19 % 12/13 % 18/19 % 12/13 % 18/19 %
C & E 1,481 1 1251 7 0 0 450 26 4 0 5 0 Cheshire
Halton & St 6,454 5 262 20 0 7,231 55 4807 43 5606 43 Helen’s Knowsley 3,285 5 0 00 0 3,822 57 2,595 44 2928 43
Liverpool 9,615 5 0 00 0 10,802 57 7244 43 8018 43
Sefton 6,649 5 0 00 0 7,286 53 5616 46 6346 47
Warrington 5,224 7 140 20 0 6,086 77 1428 21 1698 21
W 10,287 1 11,261 9 0 0 720 6 9 0 10 0 Cheshire
Wirral 14,476 1 14,106 8 0 0 2,269 14 13 0 12 0
+ CCC activity model
The model above has assumed that some of those Wirral patients who are geographically closer to Liverpool than Bebington would attend the new Centre rather than Bebington in the future. In practice, however, these patients may prefer to have their treatment on the Wirral in which case the proportion of Wirral patients being treated at Bebington in the future is likely to be higher and to come in line with the West Cheshire figure of 94%.
It should be noted that all patients would be given a choice of site, provided this was consistent with the specific treatment they required as a consequence of their type of cancer. In practice this means that almost all patients suffering from the common cancers e.g. breast, lung, prostate, colorectal, could choose which of the three sites they wished to attend for radiotherapy in future.
Chemotherapy and outpatient services A similar picture to radiotherapy is expected for outpatient chemotherapy and outpatient consultations as a consequence of the proposed changes. Wirral and West Cheshire patients would continue to have their chemotherapy provided at Bebington and to continue to have their outpatient consultations there. However patients who would currently travel to Bebington but who are geographically closer to Liverpool would instead be offered treatment at the planned new Cancer Centre in Liverpool.
Delivery of networked cancer services by CCC Overall, the Trust remains strongly committed to the philosophy of a networked model of cancer service delivery, providing care as close to the patient’s home as possible and only centralising where access to expertise or specialised equipment requires it if patients are to benefit from the best outcomes.
11. TIMESCALES
The key milestones for the Transforming Cancer Care project are shown in Table 8 below:
Table 8: key project milestones Milestone Date Publication of the Baker Cannon Report 2008 Initial feasibility study 2010-11 Approval to proceed by Merseyside NHS Cluster Board 2011 Development of the Strategic Outline Case Q3 2012 Pre-consultation public engagement Q3 2012-Q2 2013 Formal public consultation July-Sept 2014 Outline Business Case approval Oct 2014-Feb 2015 Full Business Case approval June 2016 Construction of the new Cancer Centre in Liverpool July 2016-July 2018 Refurbishment of Cancer Centre on the Wirral Sept 2018-Sept 2019
12. STAKEHOLDER INVOLVEMENT
The Consultation Plan for the Transforming Cancer Care project has been produced in tandem with this Case for Change document and is entitled ‘Transforming Cancer Services for Cheshire and Merseyside; Communication and Consultation Plan January 2014 to September 2014’. For further information on the consultation process together with stakeholder engagement, please refer to this document.
13. SUMMARY
The Transforming Cancer Care project represents an opportunity to significantly improve the way in which Cancer Care is delivered to the people of Merseyside and Cheshire, areas with some of the very worst cancer outcomes in England. It is hoped that the proposals to deliver these service changes will be endorsed by all stakeholders, enabling the vision of the Transforming Cancer Care project to be realised. The people of Wirral, West Cheshire and Merseyside deserve to have the very best in cancer services.
The Clatterbridge Cancer Centre NHS Foundation Trust Transforming Cancer Services for Cheshire and Merseyside
Communication and Consultation Plan January 2014 to September 2014
Jacqueline Robinson Head of Patient & Public Voice May 2014
Contents Pages
1. Introduction …………………………………………………………………3
2. Work done to date…………………………………………………………..4
3. The vision for transforming cancer services …………………………….6
4. Aims and purpose of communication and consultation ………………...7
5. Context for communications and consultation activity ………………..8
6. Specific stakeholder engagement plans…………………………………10
o Target Audiences
o Engagement Channels
o Stakeholder Matrix
7. Key Messages …………………………………………………………..…12
8. Milestones…………………………………………………………………..12
o Consultation
o Post-Consultation
9. References……………………………………………………….……...... 12
Appendices Appendix 1 Analysis Report by John Moores University 2013 Appendix 2 Stakeholder Matrix Model Appendix 3 Communications and Engagement Work Plan 2014
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1. Introduction
In 2008 the Merseyside and Cheshire Cancer Network (MCCN) commissioned an expert review of the configuration of Cancer Services in Cheshire and Merseyside with the aim of developing recommendations to ensure that services were delivered in the best way to improve outcomes for patients. The resulting report, ‘The organisation and delivery of non‐surgical oncology services in the Merseyside and Cheshire Cancer Network’, made a number of recommendations to improve the way non‐surgical cancer services were organised in the MCCN area.
Since then much work has been undertaken to implement the recommendations of this report and the Transforming Cancer Care project represents the culmination of this activity.
o The need to encourage the major expansion of radiotherapy through the development of satellite radiotherapy units closer to the populations served and limiting the size of major centres to a maximum of eight LINACs.
o The decentralisation of chemotherapy requiring a larger clinical workforce with a greater local presence.
o More flexible service delivery models required which were less dependent on a single centre and more served through networks of care.
o The increasing use of multi‐modality treatment regimes suggesting that, in the longer term, isolated oncology centres were no longer appropriate.
o The organisation of hospital services in MCCN meant that integrated cancer care was dependent on oncologists to secure the integrity of patient pathways. It was more difficult to achieve this from a remote centre.
o The needs of the network population were high in terms of cancer care but the results were likely to be inhibited by poor accessibility to oncology services as well as by late presentation. Closer alignment of oncology to local providers would shift the balance of leadership in cancer care and would support improving the overall organisation and delivery of care.
o Developing cancer research in Liverpool, an essential component of all cancer care and of medical research, was compromised by the absence of academic oncology leadership. The isolation of the current cancer centre and its distance from surgical oncology and MDTs were factors in the difficulty in addressing this deficiency.
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2. Work done to date
Several reports have been produced in order to understand the implications of reconfiguration. These include the Baker‐Cannon report(1) and the Ellison‐Cottier report(2). Equality issues, such as whether the reconfiguration would positively or negatively impact on a group with characteristics protected by law, have also been considered(3).
There has been significant pre‐consultation activity undertaken on the implications of the proposals contained within the Transforming Cancer Care project. This was conducted within the spirit and guiding principle of “No decision about me without me” which puts patients, service users and their carers at the centre of the decision‐making process.
The pre‐consultation exercise informed local people about the proposal and sought to find out whether they were in support of the proposed reconfiguration. It was also undertaken in order to help guide the planned formal consultation exercise and development of the business case. Local people were asked a Principal Consultation Question (PCQ):
“After finding out about the plans to develop a new Clatterbridge Cancer Centre for Cheshire and Merseyside, which would be based next to the Royal Liverpool University Hospital, do you think this is a good idea?”
Respondents could either answer yes, no or not sure. Respondents were then asked to provide comments about their chosen answer (“why do you think this?”). The data gathered was largely qualitative and therefore has been subjected to an epistemological analytic approach using Nvivo computer software. The survey data comprised 4,164 responses to the PCQ. This data also revealed that 3,755 (90%) respondents left comments to the open question within the survey. The analysis was independently undertaken by John Moores University and the report (Appendix 1) has been made available to key stakeholders as part of the feedback process.
A further Equality Impact Assessment(3) considered the responses to the PCQ in relation to where people lived and further investigates the themes arising from the additional question about why people responded to the question in the way they had.
Results 90,000 people engaged 114 roadshows 96 group sessions with 53 different groups 7 District General Hospitals participated 12 CCGs involved Every area Cancer Support Group engaged Every area Healthwatch supported the engagement Every area CVS advertised events to support attendance
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Over 40 cancer community champions recruited 14,500 visited roadshows 4,164 formal written responses
Overall, the process has given The Clatterbridge Cancer Centre a wealth of qualitative information which the Trust is committed to actively reflect within the plans as they develop.
The process has also given the Trust robust evidence and greater confidence that their proposals meet the requirements of its population. It has helped to differentiate the varying concerns of patients, carers and the public and understand these concerns in more depth. It has also confirmed to the Trust the importance of car parking and access and how robustly this must be considered and evidenced within the plans.
The analysis of 4,164 respondents found that those who opposed the reconfiguration were mainly from areas close to the current services (‘CH’ postcode) but that overall a large majority of respondents supported the proposal.
The emerging themes identified and evidenced (in alphabetical order) were: ‐
o Accessibility o Cost o Good Current Services o Ill Health o Loss of Services o Travel o Visits
These themes were observed across many responses but with Loss of Services, Cost and Good Current Services being themes particularly pertinent to “No” voters and to a lesser extent, therefore, respondents with a ‘CH’ postcode.
It is now the intention to use the information gathered from the pre‐consultation engagement work to shape a formal public consultation exercise which will be conducted from July‐September of 2014.
Therefore there are a number of phases of consultation:‐
Pre‐consultation as part of the development of recommendations was undertaken August 2012 to February 2013. Feedback on findings from the pre‐consultation was undertaken January 2014 to March 2014. Formal consultation on the actual recommendations for change is planned to commence July 2014 to September 2014. Post‐consultation feedback detailing how the decision is being implemented (dates to be agreed pending outcome of consultation).
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3. The Vision for Transforming Cancer Services
Transforming Cancer Care aims to ensure people in Cheshire and Merseyside benefit from easy access to the best clinical expertise, the most advanced treatments and the best facilities for many years to come.
We aim to achieve this through:
1. A new Clatterbridge Cancer Centre at the heart of Liverpool, centrally located for the 2.3m people in Cheshire and Merseyside, and on the same health campus as Royal Liverpool University Hospital, University of Liverpool, CR:UK’s Liverpool Cancer Trials Unit and other key research partners.
2. Continuing to provide most cancer services at The Clatterbridge Cancer Centre in Wirral in addition to the new centre on the Liverpool health campus, the satellite radiotherapy unit at Aintree University Hospital and satellite chemotherapy services at seven hospitals across Cheshire and Merseyside.
What would change?
There would be a new cancer hospital in the heart of Liverpool, closer to the c. 70% of patients who live north of the Mersey. Inpatient care would move from Wirral to the new centre in Liverpool. Some complex outpatient treatment would also move, as would the Teenage and Young Adult unit, bringing it closer to Alder Hey. For the first time, patients could access cancer surgery, chemotherapy, radiotherapy, intensive care, inpatients, outpatients, and acute medical/surgical specialties together on the same site. Seriously ill patients with complex conditions could receive treatment that can’t be provided at the moment because there is no intensive care on site at Clatterbridge. Cancer experts from different hospitals, the university and key research partners would be together, offering new scope for research. Patients could also access a much broader range of clinical trials. The Wirral site would receive further investment so local patients would continue to receive the same high standard of care for the foreseeable future.
What would stay the same?
The warm, compassionate Clatterbridge care patients value so much would also be provided in the new centre. Most Wirral and West Cheshire patients could continue being cared for at the existing centre. They would only need to travel to Liverpool for inpatient care or the more complex treatments. All outpatient chemotherapy would be available at Wirral, as well as radiotherapy for common cancers including breast, prostate and lung.
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The specialist eye proton therapy service – the only one of its kind in the UK – would also remain at Wirral. The satellite radiotherapy unit at Aintree (Clatterbridge Cancer Centre Liverpool) would remain, with radiotherapy for common cancers and the specialist stereotactic radiosurgery service for brain tumours. The satellite chemotherapy services across Cheshire and Merseyside would also continue. Patients – including those from Wirral – would receive an even better quality of care.
4. Aims and Purpose of Communication and Consultation
Under Section 242 of NHS Act 2006, providers of NHS services must make arrangements to secure the involvement of people who use, or may use services in:
Planning the provision of services; The development and considerations of proposals for change in the way those services are provided – where the implementation of the proposals would have an impact on the manner in which those services are delivered, or the range of services that are delivered; Decisions to be made by the NHS organisation affecting the operation of services.
The aim of the consultation plan is to ensure that decisions/recommendations are informed and guided by the views of stakeholders and patients, carers, and the public, which will further inform the progress of transforming cancer care across Cheshire and Merseyside.
As a major service provider, The Clatterbridge Cancer Centre is committed to providing the best possible cancer services in order to improve outcomes and reduce health inequality. Staff are one of the key stakeholders in Transforming Cancer Care. There has been regular staff engagement throughout the pre‐consultation period and lessons learnt from their feedback will be built upon. Staff will remain one of the key stakeholder groups throughout consultation and the post‐consultation period.
There will be extensive and ongoing communication and engagement through a variety of forums including roadshows, the intranet, noticeboards/newsletters, informal events and more formal involvement of staff representatives in project groups. Staff suggestions for enhancing the proposals for change – both for the new Centre and as part of the Trust’s wider organisational development plan – will be very much encouraged and valued.
Clinical engagement and support is an essential element of this project and input from specialist clinicians, clinical commissioning groups, health and wellbeing boards etc, will be sought to ensure their feedback and commentary are considered in the proposals for change.
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Local authorities have been engaged since the inception of this proposal and have received regular updates as the plan has progressed through various stages. A request will be made to convene a joint Overview and Scrutiny Committee to allow a collective forum to discuss the proposals, scrutinise the plans, hear from clinical staff involved and view the findings from the patient and public consultation.
This consultation plan seeks to:‐
o Outline the objectives for communications and consultation within the project; o Define the communications and stakeholder consultation strategic approach; o Define the development of communications and key messages; o Identify the stakeholder groups (key target audiences); o Identify the channels of communications for these stakeholders; o Plan communications and consultation activities; o Systematically record all engagement aligned to the requirements set out in 2012 Health and Social Care Act and 2006 NHS Act; o Ensure the consultation activity is aligned to best practice, in particular to:‐ o NHS England guidance as detailed within Transforming Participation in Health and Care September, 2013 o NHS England guidance as detailed within Planning and Delivering Service Changes for Patients, December 2013 o Cabinet Office Code of Conduct for public consultations o Ensure that all phases of the consultation will be composite and will be compliant with the requirements set out in the Four Tests for major service changes; o Define the means of monitoring feedback and evaluating the success of communications and engagement.
There is an absolute commitment to carry out the work with full engagement from all stakeholders, particularly local patients, carers, providers and staff.
A time‐limited group has been established by NHS England Cheshire Warrington and Wirral (CWW) Area Team, to steer the project through the consultation and scrutiny process.
5. Context for Communications & Consultation Activity
This plan supports NHS England CWW Area Team as service commissioners, and The Clatterbridge Cancer Centre NHS Foundation Trust as the service provider, in delivering their communications and engagement responsibilities. There are a number of key specific documents that have informed and shaped the communication and consultation plan which are highlighted in blue below:
Health & Social Care Act 2012 o Duty to promote the NHS Constitution (13C and 14P) o Quality (sections 13E and 14R)
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o Inequality (sections 13G and 14T), o Promotion of patient choice (sections 13I and 14V) o Promotion of integration (sections 13K and 14Z1) o Public involvement (sections 13Q and 14Z2) o Innovation (sections 13K and 14X) o Obtaining advice (sections 13J and 14W) The duty to have regard to joint strategic needs assessments and joint health and wellbeing o Section (14Z2) outlines how this legal duty for involvement: in the planning of its commissioning arrangements, in developing and considering proposals for changes in the commissioning arrangements that would impact on the manner in which services are delivered or on the range of services available, and In decisions that affect how commissioning arrangements operate and which might have such impact. o Section (14v)Duty as to Patient Choice Each CCG (who will take over from PCT post April 2013) must in the exercise of its functions, act with a view to enabling patients to make choices with respect to aspects of health services provided to them.
Government and Public Involvement in Health Act 2007 Strategies (section 116B of the Local Government and Public Involvement in Health Act 2007)
NHS Act 2006 Section 244 of the NHS Act 2006 duty to consult the relevant local authority in its health scrutiny capacity.
Public Sector Equality Duty 2010
Planning and delivering service changes for patients, December 2013, NHS England
Transforming Participation in Health and Care 2013, NHS England
Everyone Counts: Planning for Patients 2013/14, NHS England
NHS Operating Framework for the NHS in England 2013/14
Independent Reconfiguration Panel guidance o Make sure the needs of patients and the quality of patient care are central to any proposals; o Assess the effect of the proposals on others services in the area; o Give early consideration to transport and access issues; o Provide independent validation of the responses to engagement and consultation.
Rules on service reconfiguration Indicative evidence requirements against the “Four Tests’
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o Test 1 – support from GP commissioners o Test 2 – strengthened public and patient engagement o Test 3 – clarity on the clinical evidence base o Test 4 – consistency with current and prospective patient choice
6. Specific Stakeholder Engagement Plans
It is vital to involve a wide range of stakeholders in the debate for change. This will ensure that people are informed about the reasons for the proposed changes and they have an opportunity to comment on and influence these plans.
NHS Cheshire and Merseyside Commissioning Support Unit (CMCSU) will work in partnership with Voluntary and Community Sectors (VCS), locality Healthwatch and carer/patient support groups, and build upon its existing networked approach to engaging patients, carers, and the wider public. It will include the use of the community cancer champions model which proved successful during the pre‐consultation phase. This approach has been identified as crucial in reaching key stakeholders, including those traditionally hard to reach. Together the CMCSU, The Clatterbridge Cancer Centre outpatient sites and the VCS partners will work to collect views, comments and insight on patient experience and expectations.
Community champions, communities, organisations and patients and will be provided with consistent information and communication materials to share this across the sub‐ region which is inclusive of key stakeholders in the North and South Mersey regions.
The feedback from this activity will be used to inform the Outline Business Case.
As an early involvement strategy, all of Cheshire and Merseyside Healthwatch organisations, carer groups and VCS have been provided with feedback from the pre‐ consultation phase and asked for their continuing support in the formal consultation programme. This has been secured and dedicated “cancer champions” awareness events will be held to share the range of activity which is planned and allow people to choose options to volunteer.
A communications and engagement work plan has been appended (see Appendix 3). This will be a fluid plan; as new opportunities arise CMCSU will consider the capacity to add to its exiting programme of work.
Representatives from the community voluntary sector and Healthwatch have acknowledged and valued information regarding the process and have responded positively to our request for a collaboration of approach during the formal consultation period.
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Target Audiences
The approach to communication and engagement aims to be comprehensive and robust. Our aim is to work closely with key organisations that can easily communicate with a range of audiences within their networks as follows:‐
o Local residents o Patients and Carers o Third sector providers o Voluntary Patient Groups o Charities o Hospices o Hospital Trust Governors and Members o Hospital Trust Volunteers o Local Healthwatch Organisations o Local Council for Volunteer Service network o NHS England Area Teams for Cheshire and Merseyside o Cheshire and Merseyside Clinical Senates o Chairs and Chief Officers of Clinical Commissioning Governing Bodies o GPs members across Cheshire and Merseyside o Chairs of Local Medical Committees (LMCs) o Primary and Secondary Care Trust Communication and Engagement Leads o Hospital Trust Chief Executive Officers o Hospital Senior Operational Managers o Senior Consultant Cancer Clinicians o Associated Operational Clinicians and staff o Cancer Networks o The University of Liverpool o Local Authority Health Overview and Scrutiny Committees o Members of Parliament for constituent localities o Directors of Public Health o Health and Wellbeing Boards o Local media
Engagement Channels
Stakeholder engagement will be carried out through a range of channels to promote and explain the purpose and progress of the review, including:
o Senior officer meetings o Attendance at Health Overview & Scrutiny panels o Production of patient and clinician DVD to disseminate during the consultation o Corporate launch events o 2 Volunteers / Community Champion launch events o Publicity available at every GP practice
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o Local activity at all Clatterbridge Cancer Centre outpatient sites o Activity at the Royal Liverpool and Broadgreen University Hospitals NHS Trust o Targeted letters and emails o Attendance at high volume public events throughout Summer o Newsletters information within Hospital Trust membership publications o Internal staff briefings o Web based consultation information and online survey o Dedicated phone line o 10,000 leaflets distributed to cancer centres, community groups o Coverage on local Radio via live interviews and information on their website reaching the North West and Wales.
A matrix demonstrating reach to respective groups is detailed in Appendix 2.
7. Key Messages
The following key messages will be covered in all communications to all stakeholders:
The need for change Why is this a local priority Who it would affect What are the benefits What this would mean to local people and services How it would be implemented What are the timescales What can you influence What are your views on this proposal
8. Milestones
This plan is delivered in the context of a changing NHS. In order to be effective in our communications and engagement we may need to adapt this plan over time to reach our target audiences in the most effective way. Progress against the key milestones will be monitored.
Action plans for communications and engagement are set out in Appendix 3.
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References
1. Baker, M.R. and Cannon, R.C. (2008) The organisation and delivery of no‐surgical oncology services in the Merseyside and Cheshire Cancer Network: A feasibility study into the potential for the relocation of non‐surgical oncology services from Clatterbridge to Liverpool, Cancer Taskforce. 2. Ellison, T. and Cottier, B. (2009) An Analysis of Radiotherapy Services in the Merseyside and Cheshire Cancer Network, The National Cancer Services Analysis Team. 3. Hennessey, M., McHale, P. and Perkins, C. (2013) Equality Considerations in the Development of a Comprehensive Cancer Centre, 2013, Centre for Public Health: Liverpool John Moores University.
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Comprehensive Cancer Centre Pre-Consultation: Qualitative Analysis Report
June 2013
Contents Executive Summary ...... 3 1. Background ...... 5 2. Extant Literature ...... 6 3. Methodology ...... 6 3.1. Data ...... 6 3.2 Methods ...... 7 4. Key Findings ...... 8 4.1 Emerging Themes ...... 11 4.2 Themes per area ...... 14 4.3 Themes per vote ...... 17 Source: Engagement survey 2013 ...... 20 4.4 Key Postcode Analysis ...... 20 4.4.1 Accessibility ...... 20 4.4.2 Cost ...... 21 4.4.3 Good Current Health Services...... 21 4.4.4 Ill Health ...... 21 4.4.5 Loss of Services ...... 21 4.4.6 Travel ...... 21 4.4.7 Visits ...... 22 5. Summary ...... 22 6. References ...... 24 7. Appendix 1: Word Trees ...... 25 Word Tree of Responses That Include the Word “Support” ...... 25 Word Tree of Responses That Include the Word “Links” ...... 26 Word Tree of Responses That Include the Word “Idea” ...... 26 Word Tree of Responses That Include the Word “Closer” ...... 27 8. Appendix 2: Cluster Analyses ...... 28 Cluster Analysis: Postcodes Clustered by Word Similarity ...... 28 Cluster Analysis: Dendrogram of Postcodes, Vote and Themes by Word Similarity ...... 29 9. Appendix 3: Theme Report ...... 30 Theme Report: “Travel” Theme ...... 30
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Executive Summary
Following an independent review into cancer service provision, commissioned by the Merseyside and Cheshire Cancer Network (MCCN) in 2008, The Clatterbridge Cancer Centre NHS Foundation Trust (CCC) are in the process of developing a business case to reconfigure the non-surgical oncology services they provide in line with the review recommendations. In outline, the proposal is for CCC to build a new cancer centre in Liverpool to provide all oncology inpatient services and associated radiotherapy, chemotherapy and outpatient services that the Trust is responsible for. The Trust’s Wirral site would be retained and continue to provide outpatient radiotherapy and chemotherapy treatments for Wirral and West Cheshire patients who would find it easier to access the Wirral site rather than Liverpool. CCC will also retain the satellite Radiotherapy facility on the Aintree site and will continue to provide services in the existing clinics in hospitals across the region. This report contains an analysis of responses, by the Centre for Public Health (CPH), to an engagement survey, which was carried out by MCCN as part of the development of the business case.
The survey included a Principal Consultation Question (PCQ) to ascertain whether network residents were in favour of the proposed reconfiguration and the opportunity to record, in their own words their reasons why they were or were not. The data gathered is largely qualitative and therefore has been subjected to an epistemological analytic approach using Nvivo computer software. The survey data comprised 4,164 responses to the PCQ. This data also revealed that 3,755 (90%) respondents left comments to the open question within the survey.
Results The analysis found that respondents who opposed the reconfiguration were mainly from areas close to the current services (‘CH’ postcode) but that overall a large majority of respondents supported the proposal.
The emerging themes identified and evidenced (in alphabetical order) were:
Accessibility
Cost
Good Current Services
Ill Health
Loss of Services
Travel
Visits
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These themes were observed across many responses but with Loss of Services, Cost and Good Current Services being themes particularly pertinent to No voters and to a lesser extent therefore, respondents with a ‘CH’ postcode.
Recommendations Based on the analysis within this report, it is recommended that:
the business case records and reflects the reported benefits to the majority of respondents, namely reduced travel for patients and their families and a view that general accessibility using public transport will be improved by locating the service in Liverpool.
the business case includes a strategy for informing and reassuring those who oppose the proposals that the quality of service will not reduce as a result of reconfiguration.
the business case makes provision to comment, as far as possible, on the possibility of further service reconfiguration in response to concerns that this may be the start of a programme of service withdrawal.
consideration is given to how best to further communicate which patients will need to receive their care in Liverpool following reconfiguration and which will continue to be treated at the Wirral site.
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1. Background
This analysis has been commissioned by NHS Cheshire, Warrington and Wirral on behalf of themselves and NHS Merseyside.a These NHS organisations together with Specialist NHS Trusts, Acute Hospital Trusts and Hospices make up the Merseyside and Cheshire Cancer Network (MCCN)b.
In 2008, MCCN commissioned an independent review of how cancer services are organised across the region. This showed that benefits could be gained for patients and their families by expanding the services provided by The Clatterbridge Cancer Centre NHS Foundation Trust (CCC). The review recommended the establishment of a comprehensive cancer centre. The establishment of such a centre would involve the reconfiguration of current services such that inpatient services currently provided at The CCC on the Wirralc would be located adjacent to the redeveloped Royal Liverpool University Hospitald as well as associated radiotherapy, chemotherapy and outpatient services that the Trust is responsible for.
The Trust’s Wirral site would be retained and continue to provide outpatient radiotherapy and chemotherapy treatments for Wirral and West Cheshire patients who would find it easier to access the Wirral site rather than Liverpool. CCC will also retain the satellite Radiotherapy facility on the Aintree site and will continue to provide services in the existing clinics in hospitals across the region.
Further work is being carried out in order to develop a business case for the proposed investment. An engagement exercise with the local populations who might be affected by the proposed reconfiguration has been carried out and this report contains an analysis of the responses to that consultation. This engagement exercise was designed to inform local people about the proposal, find out whether they were in support of the proposed reconfiguration and inform the formal consultation exercise and development of the business case. Local people were asked a Principal Consultation Question (PCQ):
“After finding out about the plans to develop a new Clatterbridge Cancer Centre for Cheshire and Merseyside, which would be based next to the Royal Liverpool University Hospital, do you think this is a good idea?”
Respondents could either answer yes, no or not sure. Respondents were then asked to provide comments about their chosen answer (“why do you think this?”). This analysis considers the responses to the PCQ in relation to where people lived and further investigates the themes arising from the additional question about why people responded to the question in the way they had. a These organisations are due for reorganisation under NHS reforms and cease to exist at the time of publication b For a full list of network members, see http://www.mccn.nhs.uk/index.php/about_us_network_organisations c Hereafter referred to as CCC d Hereafter referred to as the Royal Liverpool 5
2. Extant Literature
Several reports have been produced in order to understand the technical and costing implications of reconfiguration. These include the Baker-Cannon report[1] and the Ellison- Cottier report[2]. Equality issues, such as whether the reconfiguration would positively or negatively impact on a group with characteristics protected by law, have also been considered[3]. These reports recognise that reconfiguration will have travel implications for those currently living near to the current and proposed sites. The reports conclude that there will be some people who will experience reduced travel as a result of the proposal and some for whom journey time will increase. Overall, the reports find that a majority of future patients will experience reduced travel time based on where the burden of disease lies within the MCCN population. The reports also find that a relatively small population experience direct travel benefits from the current service location and these benefits are no longer realised once the public transport journey time exceeds about 15-30 minutes.
3. Methodology
3.1. Data This analysis is drawn from survey data taken from a survey sample of 4,164 respondents. Cleaned data revealed that 3,755 (90%) respondents left comments to an open question within the survey. The data presented was predominantly qualitative requiring an epistemological approach and a method based on critical realism.
In order to provide quantitative and qualitative analyse of the data by location, respondents had the opportunity to record their postcode along with their responses. There was a variety of responses gathered with some respondents providing a full postcode, and some only a partial postcode. In a few cases no postcode was given (n=23). In view of this data inconsistency a number of geographies have been prepared to enable analysis to take place (Table 1)
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Table 1: Postcode Geography Definitions
Geography Geography Definition Name
1 Liverpool Contains all postcodes beginning “L” (Liverpool postal district). It does not including “LL” which is a N Wales Postcodes postcode district
2 Cheshire Contains all postcodes beginning “CH” (Chester postal district). The CH postcode is the most coterminous Postcodes postcode for the Local Authority Footprints of Wirral, and Cheshire West and Chester. The classification of ‘Cheshire’ used here is purely for ease of presentation and does not include postcodes relating to the Cheshire East Local Authority (“CW” or Crewe postcodes)
3 Manchester Contains all postcodes beginning “M” Postcodes
4 Warrington Contains all postcodes beginning “WA” Postcodes
5 Wigan Postcodes Contains all postcodes beginning “WN”
6 Miscellaneous Contains all postcodes not allocated to geography 1-5 above (Liverpool – Wigan). Examples include “CW” “LL”, Postcodes “PR”, “SY”, “ST”, “SK”, “NG” and “VH”
7 Other Area This grouping includes all non-Liverpool postal district (L) or Chester postal district (CH) postcodes Postcodes
11 Not Known Either no postcode was provided or location based on classifications above could not be determined
3.2 Methods A combination of content analysis and initial evaluation using Computer Assisted Qualitative Data Analysis Software (CAQDAS) package Nvivo 10 was applied to the data. CAQDAS assists in the identification of emerging themes using textual analysis. The data analysed included no missing responses in respect of the overall ‘yes, no or not sure’ consultation question. However, the optional follow up question responses contained some missing or textual errors. This qualitative analysis is broadly based upon Grounded Theory and uses a process of open coding and axial coding to extract and distil themes from the free text responsese. Grounded Theory in its purest form is entirely data directed and presupposes no specific themes from the data. In this scenario, it is clear that there are some constraints on being able to follow a pure Grounded Theory methodology. The pre-consultation builds on the extant literature and is structured on a premise that the reconfiguration will cause a difference of opinion between local groups, most likely with differences observed between groups who live near to the current or proposed sites. In this respect the analysis should be considered semi-inductive, that is to say that the analyst will investigate some expected themes in relation to location.
e Grounded Theory involves taking raw data and systematically distilling it to form a theory. Key points in the data are coded and then these codes are combined to form themes and concepts which can be developed into a theory. 7
4. Key Findings
Analysis of the PCQ shows that significantly more people voted in support of the proposed changes and also that there is a significant difference in the PCQ responses of different locations. Figure 1 illustrates that the number of people who support the proposed reconfiguration is greatest from locations with a Liverpool postcode.
Figure 1: Distribution of Votes by Postcode Area
Number of Votes
Postcode Area
Source: Engagement survey 2013
Figure 2 shows the percentage of votes cast in the PCQ by each postcode area. Cheshire postoces dominated the No vote with Liverpool Postcodes recording the highest percentage of Yes vote. Warrington and Cheshire postcodes make up the majority of undecided voters.
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Figure 2: Percentage of No, Yes and Not Sure votes by Postcode Area
Source: Engagement survey 2013 A Tree Map (Figure 3) can be used to illustrate the responses at a lower geography, displaying what proportion of votes came from each postcode. As Figure 3 shows ‘No’ votes were predominant in CH postcodes with CH64, CH43, CH62, CH45 and CH63 being ‘No Hotspots’. Warrington Postcodes made up a substantial proportion of the votes from people who were undecided. ‘Yes Hotspots’ included L36, WA7, L32, L35 and L33. This report will go on to consider the responses from these postcodes, designated ‘Yes’ and ‘No’ Hotspots, in more detail (Section 4.4).
Figure 3: Distribution of Postcodes by Vote
Source: Engagement survey 2013
Figures 4 and 5 show how Yes and No votes were distributed across the MCCN footprint.
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Figure 4: Map of the Distribution of Yes Votes across the MCCN
Source: Engagement survey 2013
Figure 5: Map of the Distribution of No Votes across the MCCN
Source: Engagement survey 2013
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In order to place these responses in some context the current geographical distribution of people attending for in-patient treatment at CCC is shown in Figure 6. Comparing the maps it can be seen that the No Hotspots correspond with the areas on the map with high representation in the in-patient treatment population.
Figure 6: Distribution Map of Clatterbridge Inpatients
Source: CCC data 2013
4.1 Emerging Themes
A basic word frequency query was used to identify the words that were most commonly used in people’s free text responses (e.g. detailing why they said yes, no or not sure to the PCQ). These words can be visually presented in a tag cloud where the size of the word is proportionate to the number of times it appearsf. Figure 6 shows the tag cloud for all the responses.
f The more often a word appears the bigger it is in the tag cloud 11
Figure 7: Word Frequency Tag Cloud for All Responses
Source: Engagement survey 2013 This word frequency investigation formed the basisof the open coding. A coding model (Figure 8) shows how themes were distilled from the datatset. In this first round of coding 33 common themes were identified. These included themes (in no particular order) like Idea, Stress, Travel, Links, Distance, Visits, Treatment, Travel, Support and Time.
Figure 8: Research Coding Model
Source: Engagement survey 2013
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The context of each theme was explored using word trees to understand more about the context that each word was used in. For example, the word “stress” was used 102 times across all the responses. Figure 4 shows the context surrounding the word.
Figure 9: Word Tree of Responses that Include the Word “Stress”
Source: Engagement survey 2013
From this it is possible to see that the word ‘stress’ is most commonly used in the context of travelling to receive treatment. A typical response is provided below:
Reference 39 Having Cancer is a stress in the first place. Having to travel further for a treatment only adds to the stress.
Appendix 1 contains more word trees for some of the other ambiguous themes
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The 33 initial themes were axially coded or distilled using these methods into 7 main themes emerging from this engagement exercise. These are:
Accessibility
Cost
Good Current Services
Ill Health
Loss of Service
Travel
Visits.
Having obtained these key themes, it is possible to repeat this exercise for smaller populations than the overall survey sample, such as groups from the same postcode area or those who voted either Yes, No or Not Sure
4.2 Themes per area
The overall PCQ analysis showed that respondents from Cheshire Postcodes and those from Liverpool Postcodes tended to demonstrate different voting behaviours. Analysing and comparing the word frequency of these two groups makes the reasons for their different positions clearer.
Figure 10a and 10b show the word frequencies for the two postcode areas. While many of the words are similar, suggesting that they have a similar understanding of the proposition and share some of the same views, there are notable differences.
For example, the words Costs, Parking and Tunnel have a greater prominence in responses from Cheshire. The word Tunnel is mentioned 10 times across Liverpool responses but 29 times in Cheshire responses (Table 2).
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Figure 10a Word Frequency Tag Cloud for Cheshire Postcode Responses
Source: Engagement survey 2013
Figure 10b Word Frequency Tag Cloud for Liverpool Postcode Responses
Source: Engagement survey 2013
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Table 2: Number and percentage of responses that include the word “Tunnel”
Not Warrington Cheshire Liverpool Manchester Miscellaneous Wigan Known
Number of responses containing "Tunnel" 2 5 29 10 0 0 1
Total number of responses 19 1,008 792 1,776 5 117 38
Percentage of responses which contain "Tunnel" 10.53 0.50 3.66 0.56 0.00 0.00 2.63
Source: Engagement survey 2013
Another theme that emerged with a greater prominence from Cheshire responses was satisfaction with current services – the prominence of words like ‘excellent’ and ‘stay’ drew attention to the comments about the ‘excellent’ quality of current services and the request to let things ‘stay’ as they are. The following comments were typical of this theme.
Reference 38 I am a patient who has had an excellent series of treatments at Clatterbridge Oncology Centre. It is a well organised and pleasant convienent hospital to attend.
Reference 96 There is already an excellent system at clatterbridge which should be further invested in
Reference 105 As long as the new centre does not replace Clatterbridge, where my father received excellent treatment
Reference 12 Because have used services at Clatterbridge and would like it to stay as it is
Reference 18 Services need to stay on the Wirral
Reference 24 Clatterbridge has such a good reputatuon and should stay as it is
Reference 40 Having been treated at Countess and Clatterbridge would prefer services to stay nearby
Liverpool postcode responses tended to record that a service that ‘closer’ to home was one reason why respondents had voted the way they had. The number of comments about ‘travel’ as evidenced by its relative size in the tag cloud reinforces this point. The idea that services should be based near to where the greatest need was echoed in responses from Non Cheshire-Liverpool postcodes (see Appendix 1 for ‘closer’ word tree)
Figure 11 shows a cross tabulation of the key thematic content by Postcode Area. From this analysis it is clear that the notion of travel and accessibility whilst potentially feeling unwell and issues related to visiting are a common themes for Liverpool postcode respondents and a large majority of respondents overall. Cheshire respondents were raising concerns of cost and pointing out their satisfaction with current services.
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Figure 11: Number of Coded Responses by Key Theme and Postcode Area
Number of Coded Responses
Source: Engagement survey 2013
4.3 Themes per vote
It should be noted that not everyone in a particular area voted the same way. For example, taking the two postcodes where the number of votes for and against were highest or most polarised (CH64 – ‘No’ and L36 – ‘Yes’) it can be seen that voting was not unanimous.
Table 3: Percentage of Respondents from Selected Postcodes voting Yes, No and Not Sure % Voting 'No' % Voting 'Yes' % Voting 'Not Sure' Postcode = CH64 63.5 23.8 12.7 Postcode = L36 1.0 98.0 1.0 Source: Engagement survey 2013
In view of this it is appropriate to investigate the themes that emerged from those who indicated support for the proposal and those who opposed it. Using similar analytical methods it can be seen that ‘Yes’ voters were reporting travel, closeness of services and meeting the needs of family. ‘No’ voters reported concerns about parking, travel, inconvenience and commented on the excellent quality of current services (Figures 12a and 12b). 17
Figure 12a: Word Frequency Tag Cloud for Yes Responses
Source: Engagement survey 2013
Figure 12b: Word Frequency Tag Cloud for No Responses
Source: Engagement survey 2013
18
The different perspective of the two groups is also observed in the analysis of the key themes. Figure 13 shows the number of comments made in respect of each theme by the two groups and it is striking that the number of comments relating to accessibility made by the Yes group outnumber all the comments relating to key themes made by the No group. However it is important to ensure that the total number of respondents in each group does not distort the picture – there were many more yes vote responses than no vote responses. For example, the number of ‘cost’ comments from the ‘no’ voter group is quite similar to the number made by the ‘Yes’ group but as Figure 14, which is a presentation of themes as a percentage of comments made by each group, shows there is a greater proportion of ‘cost’ comments coming from the ‘no’ voter group. In this respect it is easy to compare which themes were particularly pertinent to each group.
Figure 13: Number of Coded References of Key Theme By Yes/No Vote
Yes Vote Content A : Accessibility B : Cost C : Good Current Services D : Ill Health E : Loss of Services F : Travel No Vote Content G : Visits
0 500 1000 1500 2000 2500 3000 3500
Source: Engagement survey 2013
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Figure 14: Key Themes Expressed as a Percentage of the Yes and No Votes
Source: Engagement survey 2013
4.4 Key Postcode Analysis
Having identified that there are different perspectives across groups of voters and that these voters were generally split by location (Cheshire/Liverpool), it is worth considering in a little more detail what respondents are actually saying about the key themes. In order to do this, analysis has been focussed on the responses of those areas with the most polarised views. i.e. postcodes that could be described as being ‘Yes’ or ‘No’ vote Hotspots.
Figure 15: Number of Coded References by Theme and Vote Hotspot
A : No Hotspot B : Yes Hotspot 1 : Accessibility 84 217 2 : Cost 84 45 3 : Good Current Services 38 27 4 : Ill Health 8 40 5 : Loss of Services 5 - 6 : Travel 104 425 7 : Visits 35 112 Source: Engagement survey 2013
The themes are considered in detail below:
4.4.1 Accessibility The accessibility theme is defined by issues of transport and travel, but more specifically this theme includes references to the availability of public and private transport, parking and congestion. In general, ‘No’ Hotspot responses recorded that a move would reduce accessibility for them and ‘Yes’ Hotspot respondents reported that accessibility would be improved because of the transport infrastructure in Liverpool. A detailed analysis of Hotspot
20 responses showed that ‘No’ vote responses considered Clatterbridge to be accessible as it was close to the motorway and that Liverpool was inaccessible due to parking and congestion. ‘Yes’ vote responses focussed on what they believed to be better public transport network to Liverpool.
4.4.2 Cost Although cost was mentioned in several different contexts, the majority of the cost references were in respect of the additional costs of travel, such as parking, taxis and tunnel fares. ‘No Hotspot’ respondents tended to report that the tunnel costs would be additional to them if the service moved whereas ‘Yes Hotspot’ respondents reported that taxi fees were currently additional for them.
4.4.3 Good Current Health Services Comments relating to this theme were made in qualification of a preference to keep services in Clatterbridge. Many respondents spoke of excellent services and the notion of ‘if it ain’t broke don’t fix it’ was expressed.
4.4.4 Ill Health Respondents who have had personal experience of cancer treatment (either themselves, a friend or relative) reported on the difficulties of travelling when feeling unwell. Respondents from ‘Yes Hotspot’ postcode areas in particular commented on this issue with 40 ‘ill health’ references being reported against 8 from the ‘No Hotspot’.
4.4.5 Loss of Services The loss of services was a concern for a particular minority of voters. This theme was especially linked with those who reported personal experience of current service provision in ‘No Hotspot’ postcodes. In some of these cases it was clear that the respondent felt that this might be the thin end of a wedge, resulting in the ultimate closure of services and loss of jobs at Clatterbridge. For example:
Reference 2 A devious way of closing the oncology unit at Clatterbridge, which is highly regarded for people in Wirral, Cheshire and N. Wales
Two respondents made specific reference to the relocation of other health services away from the Wirral.
4.4.6 Travel Travel is by far the most commented on theme to emerge from the responses. Travel comments are predominantly related to distance. Issues of general transport availability have been collected under the accessibility theme. However, reference to transport ‘links’ have been recorded within this theme. The majority of those comments relating to travel come from respondents with Liverpool postcodes and reflect the opinion that current provision is ‘too far’. Many made reference to the difficulties of travelling when ill. A typical response is recorded below:
21
Reference 1 Family have been affected by cancer and the travel to Clatterbridge took alot out of them when they were unwell. It was too far.
4.4.7 Visits Many respondents were clearly able to draw on personal experience of cancer treatment services. Analysis shows that some 75 references were made to parents who had cancer and had used services. Many of these comments were surrounded by reflections on travel and accessibility for the individuals who were receiving treatment but many also commented about the importance of the patient’s support network and therefore the need to make it easy to visit. Analysing hotspot responses in respect of this theme, it is clear that the No Hotspot respondents valued the proximity of current services to them and their family, whereas Yes Hotspot respondents reported the difficulty families had travelling to Clatterbridge.
Appendix 3 includes examples of these responses.
5. Summary
The qualitative analysis identifies and evidences the following emerging themes (in alphabetical order):
Accessibility
Cost
Good Current Services
Ill Health
Loss of Service
Travel
Visits
These themes were generally observed across the whole dataset but it is clear that different perspectives exist between those who voted ‘Yes’ and those who voted ‘No’. There was also a geographical dimension to the responses but as Figure 16 shows this was not as strong an association as voting behaviour.
The Cluster Analysis (Figure 16) uses statistical methods to chart the similarity of the words used by the groups selected and the spatial relationship between objects in the chart shows how similar they are. The closer together a group the more similar the content of the responses. From this chart it is possible to see that ‘No’ votes are the ones most closely
22 associated with some of the themes like Ill health, Loss of Services , Cost and Good Current Services.
Figure 16: Cluster Analysis of Themes, Votes and Postcode Area by Word Similarity
Source: Engagement survey 2013
Based on the analysis within this report, it is recommended that:
the business case records and reflects the benefits that the majority of respondents reported, namely reduced travel for the majority of patients and their families and a view that general accessibility using public transport will be improved by locating the service in Liverpool.
the business case includes a strategy for informing and reassuring those who oppose the proposals that the quality of service will not reduce as a result of reconfiguration.
the business case makes provision to comment, as far as possible, on the possibility of further service reconfiguration in response to concerns that this may be the start of a programme of service withdrawal.
consideration is given to how best to further communicate which patients will need to receive their care in Liverpool following reconfiguration and which will continue to be treated at the Wirral site.
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6. References
1. Baker, M.R. and Cannon, R.C. (2008) The organisation and delivery of no-surgical oncology services in the Merseyside and Cheshire Cancer Network: A feasibility study into the potential for the relocation of non-surgical oncology services from Clatterbridge to Liverpool, Cancer Taskforce. 2. Ellison, T. and Cottier, B. (2009) An Analysis of Radiotherapy Services in the Merseyside and Cheshire Cancer Network, The National Cancer Services Analysis Team. 3. Hennessey, M., McHale, P. and Perkins, C. (2013) Equality Considerations in the Development of a Comprehensive Cancer Centre, 2013, Centre for Public Health: Liverpool John Moores University.
24
7. Appendix 1: Word Trees
Word Tree of Responses That Include the Word “Support”
25
Word Tree of Responses That Include the Word “Links”
Word Tree of Responses That Include the Word “Idea”
26
Word Tree of Responses That Include the Word “Closer”
27
8. Appendix 2: Cluster Analyses
Cluster Analysis: Postcodes Clustered by Word Similarity
Yes Cluster
No Cluster
28
Cluster Analysis: Dendrogram of Postcodes, Vote and Themes by Word Similarity
The closer together items are in the tree above, the more similar their word content: For example, the responses the mention ‘accessibility’ were most similar to responses from WA7 and WA postcodes
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9. Appendix 3: Theme Report
Theme Report: “Travel” Theme Appendix_Travel report (excerpt)
Name Description Number Of Coding Coded Text Percent Coverage Of References Source Travel Report 0
Travel Report Key Theme. Distilled 1,733 A centre for the care of 0.02 % from references relating cancer patient and for to Travel. Includes research in to finding Stemmed words and cures would be one of synonyms for...Distance, the most useful Far, Near, Journey establishments one could hope for. Especially now that so many advancements have been made. Things will get better. Travel Report Key Theme. Distilled 1,733 A centre of excellence 0.02 % from references relating seems a good idea, as to Travel. Includes long as it does not take Stemmed words and money and resources synonyms for...Distance, from local services. Far, Near, Journey Travel Report Key Theme. Distilled 1,733 A city like Liverpool 0.02 % from references relating should have its own to Travel. Includes centre to ease the Stemmed words and burden of travelling to synonyms for...Distance, clatterbridge Far, Near, Journey Travel Report Key Theme. Distilled 1,733 A devious way of closing 0.02 % from references relating the oncology unit at to Travel. Includes Clatterbridge, which is Stemmed words and highly regarded for synonyms for...Distance, people in Wirral, Far, Near, Journey Cheshire and N. Wales Travel Report Key Theme. Distilled 1,733 a good place to go good 0.02 % from references relating bus service and train to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey Travel Report Key Theme. Distilled 1,733 A layman's view. 0.02 % from references relating Provided the service to Travel. Includes currently available at the Stemmed words and existing Clatterbridge synonyms for...Distance, site is not diminished in Far, Near, Journey any way then the new proposal is an excellent idea otherwise not so. To avoid confusion the Liverpool site should Travel Report Key Theme. Distilled 1,733 Ahave long a wayseparate from namehome. 0.02 % from references relating to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey
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Travel Report Key Theme. Distilled 1,733 A long way to travel 0.02 % from references relating when visiting to Travel. Includes Clatterbridge, so the Stemmed words and Royal will be good. synonyms for...Distance, Far, Near, Journey Travel Report Key Theme. Distilled 1,733 A lot more research and 0.02 % from references relating treatment is needed to to Travel. Includes help people with cancer Stemmed words and and also to help families synonyms for...Distance, come to terms with their
Far, Near, Journey diagnosis. Reports\\Appendix_Travel Report (excerpt) Page 1 of 185
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Authors: Matthew Hennessey
Centre for Public Health Research Directorate Faculty of Health and Applied Social Sciences Liverpool John Moores University 2nd Floor, Henry Cotton Campus 15-21 Webster Street Liverpool L3 2ET
Tel: +44 (0)151 231 4535 Fax: +44 (0)151 231 4552
Email: [email protected] Web: www.cph.org.uk
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APPENDIX 2 – CLATTERBRIDGE CANCER CENTRE STAKEHOLDER MAXTRIX MODEL
Stakeholder Level Level of Communications / Engagement Channels Methods of Communication/Engagement Group of Influence Meetings Forums Briefings Newsletter Local Interest (1-5) / Events / Email / Media (1-5) Letter Patient and 5 4 Cheshire and Merseyside Healthwatch X X X X X Public Groups Members of the public X X X X Previous attendees at pre-consultation X X X sessions X X X X Patients X X X X X Patient and carer support groups X X X X X Wider Voluntary and Community X X X X X Sector (including people under protected characteristics and hard to reach groups)
NHS England 5 5 NHSE Managing Directors X X X NHSE Specialist Commissioning X X X (Cheshire, Warrington,Wirral) NHSE Medical Director X X X NHSE Lancashire X X X (external assurance team) Clinical 5 5 NHSE Managing Directors X X X Commissioning Cheshire and Merseyside CCG Boards X X X Groups Cheshire and Merseyside GPs X X (via CCG Boards communications) members Chairs of LMCs X X X (via CCG Boards communications) Communication and Engagement X X X Leads
APPENDIX 2 – CLATTERBRIDGE CANCER CENTRE STAKEHOLDER MAXTRIX MODEL
Hospital Trusts 5 4 Chief Executive Officers X X X Members of Strategic Overview Group X X X Clinicians X X X Non-medical professionals X X X Senior Operational Managers X X X Trust Governors X X X Trust Non Executive Directors X X X X X X X Trust Members X X X X Patient Reference Group X X X X Members X X X X Staff members X X X X Trade Union representatives Political 5 5 Constituent MPs X X X X Leaders/ Local Overview and Scrutiny Panels X X X X Authorities Elected members X X X Chief Executive Officers X X X Healthand Wellbeing Boards X X X X Directors of Public Health x X X X NHS Specialist 5 5 NHS England Cheshire, Warrington & X X X Commissioners Wirral NHSE England Lancashire Area Team X X (external assurance)
Other 4 4 NHS Gateway X North West Ambulance Service X Strategic Clinical Network X Merseyside and Cheshire Cancer X X X Network X X Universities X Charities X X APPENDIX 2 – CLATTERBRIDGE CANCER CENTRE STAKEHOLDER MAXTRIX MODEL
Hospices Communication 5 3 Local press releases/other proactive X Channels media X Radio X Event advertisements X Posters in clinical and community X facilities X Hospital Trust and Commissioning Support Unit network
THIS PAGE IS LEFT BLANK INTENTIONALLY
APPENDIX 3 – STRATEGIC COMMUNICATION AND ENGAGEMENT PLAN
STAGE ONE - STRATEGIC COMMUNICATION AND CONSULTATION PERIOD
No. TASK / KEY ACTIONS TIMESCALE LEAD PROGRESS RAG RATING RESPONSIBILITY 1. Scope key stakeholders Review all work Jan-Mar 14 CSU Completed undertaken in pre- consultation and feedback sessions 2. Keep CCC staff, patients Articles in CCC Jan-Sep 14 CCC Completed (Jan-May); on track for May- and members informed magazine 3 x year; Sep monthly Team Brief updates; press releases; staff events etc 3. Plan stakeholder events Ensure inclusion of Feb-May 14 CSU Completed and meetings all constituent areas, adherence to equality duties (protected characteristic groups) 4. Ensure adherence to Keep scrutiny Jan-Sep 14 CSU Work in progress and delivery on track requirements in Health officers appraised and Social Care Act of proposal plans to 2012 (including duties to align dates without consult Overview & impact on purdah Scrutiny) and that public consultation is 12 weeks with time for OSC consideration as part of its consultation 5. Overview and Scrutiny Joint letter with May 2014 NHS England Completed
Green – Completed. Amber = In progress / on track. Red = Not started. APPENDIX 3 – STRATEGIC COMMUNICATION AND ENGAGEMENT PLAN
NHS England to and CCC local authority overview and scrutiny committees 6. Prepare consultation Prepare full and Apr-Jun 14 CCC Work in progress and delivery on track materials summary consultation documents, consultation questions, information film and supporting materials and share with patient reference group for feedback 7. Consultation website Prepare online May-Jun 14 CCC Work in progress and delivery on track and social media versions of consultation documents & films, and finalise digital/social media campaign (Twitter, YouTube etc) 8. Brief MPs Write to MPs to May-Jun 14 NHS England To be actioned – plan in place inform them of & CCC public consultation (follows ongoing process of meetings and briefings via CCC Chair) 9. Procure and conduct Carry out further Jun-Aug 14 CCC Work in progress and delivery on track Equality Impact analysis on more Assessment detailed clinical
Green – Completed. Amber = In progress / on track. Red = Not started. APPENDIX 3 – STRATEGIC COMMUNICATION AND ENGAGEMENT PLAN
proposals as recommended by earlier EIA 10. Procure external Academic Health May 14 CCC Work in progress and delivery on track evaluator Science Network to support procurement 11. Advertise consultation Book advertising in Jun 14 CCC To be actioned – plan in place selected media outlets (print/radio) 12. Hold information Request support Jun-Jul 14 CCC/CSU Work in progress and delivery on track sessions for key from partner stakeholder partners organisations and communities to help steer and disseminate/deliver on consultation activity 13. Print and distribute Print consultation Jun 14 CCC/CSU To be actioned – plan in place consultation materials materials and distribute to key sites/venues 14. Media briefings Pre-consultation Jun 14 CCC To be actioned – plan in place briefings for key media across Cheshire and Merseyside to support communication and publicity 15. CCC Governor briefing Brief CCC Jun 14 CCC Work in progress and delivery on track foundation trust Council of Governors
Green – Completed. Amber = In progress / on track. Red = Not started. APPENDIX 3 – STRATEGIC COMMUNICATION AND ENGAGEMENT PLAN
16. Begin formal 12 week Ensure the plans Jul-Sep 14 CSU To be actioned – plan in place public consultation are flexible to add Attend Overview and more activity as Scrutiny Meetings new information or public member opportunities arise. Including CCC staff events, Healthwatch, patient groups, public meetings / events etc. 17. Distribute press Sustained proactive Jun-Sep 14 CCC To be actioned – plan in place releases and arrange media campaign media interviews / across Cheshire ongoing activity and Merseyside, publicising consultation and local events 18. Begin consultation with Support scrutiny Jul-Nov 14 CCC/CSU To be actioned – plan in place Overview and Scrutiny officer leading on Meetings behalf of Local Authorities for attendance and submission of materials ahead of meetings. 19. Collate Feedback Collate qualitative Sep 14 CSU To be actioned – plan in place and statistical feedback information for external review 20. Begin external analysis Procured Sep-Oct 14 TBA – To be actioned – plan in place of findings organisation to procurement review data and underway
Green – Completed. Amber = In progress / on track. Red = Not started. APPENDIX 3 – STRATEGIC COMMUNICATION AND ENGAGEMENT PLAN
qualitative feedback and write up findings
21. Feedback report Analysis report sent Oct 14 To be actioned – plan in place produced for Trust to Trust executive team 22. Feedback report Share findings of Oct 14 To be actioned – plan in place produced for Overview consultation with and Scrutiny scrutiny committee
STAGE TWO- POST CONSULTATION STAGE
No. TASK / KEY ACTIONS TIMESCALE LEAD PROGRESS RESPONSIBILITY 1. Receive feedback Provide all Oct-Nov 14 CCC Feedback plans dependent on outcomes from Overview documents on andScrutiny request to support Committee scrutiny in its functions
2. Share scrutiny Report scrutiny Nov 14-Jan 15 CCC Feedback plans dependent on outcomes findings with CCC feedback for Trust Board consideration and response, as appropriate.
Green – Completed. Amber = In progress / on track. Red = Not started. APPENDIX 3 – STRATEGIC COMMUNICATION AND ENGAGEMENT PLAN
STAGE TWO- POST CONSULTATION STAGE
No. TASK / KEY ACTIONS TIMESCALE LEAD PROGRESS RESPONSIBILITY Review/finalise Outline Business Case as appropriate. Inform NHS England and Monitor through the assurance process, as appropriate 3. Feed back findings to Comprehensive TBC – CCC Feedback plans dependent on outcomes all key stakeholders communications dependent on outlined in plan to feed back outcome of consultation and results via proactive scrutiny ensure range of media, CCC mediums used to website, disseminate broadly presentations to at using technology key stakeholders where appropriate etc
Green – Completed. Amber = In progress / on track. Red = Not started. 8ppA5_EngagementFeedback5 copy.pdf 1 08/01/2014 13:28
Transforming Cancer Care in Cheshire and Merseyside
An independent review of cancer care across the region concluded that big benefits could be gained for patients and their families by expanding the services provided by The Clatterbridge Cancer Centre.
What happens next?
Getting your feedback We plan to launch a formal 12 week The Clatterbridge Cancer Centre What are the proposals? consultation period in the Spring/ want to make sure that everyone in The proposals would see Clatterbridge Cancer Centre services expanded The Clatterbridge Cancer Centre Voting boxes were also placed in Summer of 2014 which will enable us Cheshire and Merseyside can access Transforming with the building of a new cancer centre for Cheshire and Merseyside next need to get the views of patients, hospitals and a variety of community to explore the main themes you have the right cancer services, at the right to the new Royal Liverpool University Hospital. families and the wider public if we are venues, cancer support groups and identified in more detail. time and in the right place. to develop services that fully meet charities across Cheshire and Cancer Care in Inpatient services will move from Wirral to the Liverpool site and additional your needs. Merseyside. Feedback will be used to develop We thank everyone who has taken outpatient services will also be provided. more detailed proposals for the the trouble to get involved so far. Your To learn what you think about the centre for submission in the comments will be invaluable as we Our staff spoke to Only those Wirral based patients, who need more complex treatment, or proposals we used a variety of Autumn of 2014. continue to plan and develop our new Cheshire and an overnight hospital stay, will need to travel to the new centre in Liverpool. different ways to give people the members of the public cancer services for the next 25 years. opportunity to share their views about the proposals, For details of how you can get Outpatient radiotherapy and chemotherapy for the more common cancers with us. involved in the formal consultation distributed information Merseyside - such as breast or prostate - will continue to be provided at the keep your eye on the local press or Wirral site. The UK’s only proton beam therapy service will also remain at From August 2012 to March 2013 leaflets and showed a short visit www.actiononcancer.org.uk members of the public attended DVD before asking people: the Wirral site. events, completed an online survey or visited our customised ‘Action on The new centre in Liverpool means that Cheshire and Merseyside cancer The full feedback report and analysis patients will have access on one site to expert surgery, inpatient care, Cancer Trailer’ which we took to busy “Having heard about the shopping centres across Cheshire radiotherapy, chemotherapy, critical care, outpatient clinics and enhanced and Merseyside. proposals do you think document is available to view at research and development with clinical trials. they are a good idea?” www.clatterbridgecc.nhs.uk Thank you if you gave us your views during this initial consultation period. 8ppA5_EngagementFeedback5 copy.pdf 2 08/01/2014 13:28
Who responded? What they told us Travel accessibility for them. They consider Expense The Clatterbridge Cancer Centre We reached approximately 90,000 “Having heard about the proposals do you think they are a good idea?” Travel is a key emerging theme. The Wirral to be accessible as it is close The majority of the references to
Sefton majority of comments relating to travel to the motorway and that Liverpool expense were in respect of the people; with 14,000 people Knowsley Halton St Helens would be inaccessible due to parking L Responses broken down by Postcode Area came from respondents in support of additional costs of travel, such as WA and congestion. accessing the Action on Cancer trailer Liverpool the proposals and reflect the opinion parking, taxis and tunnel fares. L L that the existing Cancer Centre is ‘too Wirral CH includes Wirral, Flintshire, Cheshire and a total of 4,164 responses ALL POSTCODES far’ from where they live and the new “Clatterbridge should stay as “A lot of cancer patients are CH West and Chester returned. centre will be beneficial in terms of main hospital. It has the space for quite elderly and cannot travel Ill Health No No distance, time and money saved. development. The Royal is to Clatterbridge and cannot 12.70% 49.75% congested by area and afford taxis.” Respondents who have had personal 96 visits were made to 53 unique accessibility.” Yes Yes “My family have been affected by Cheshire experience of cancer treatment groups across Cheshire and 82.63% 40.53% cancer and the travel to Comments on cost were balanced. reported on the difficulties of travelling CH Clatterbridge took a lot out of Those respondents in support of the Liverpool postcode residents Not Not when feeling unwell. Merseyside to speak to patients and Sure Sure them when they were unwell. It plans felt that accessibility would be considered it to be positive as they 4.66% 9.72% improved because of the transport was too far.” would save money on tunnel fares. “A new centre will provide easier members of the public. infrastructure in Liverpool. Other ‘yes’ voters believed that a access for patients at a time Costs, parking and tunnel were also better transport infrastructure would when they would prefer to be “I live in Wallasey but I am sure it key words mentioned by South reduce the amount of taxi journeys nearer to home. Travelling can be L includes Liverpool, Sefton (including PR8 WA Warrington, Widnes, Runcorn and would be easier for me to use and PR9 postcodes) and Knowsley St Helens Mersey residents in relation to required to the new site. stressful especially when public transport to get to travelling to the new centre in someone is ill.” Analysis of the questionnaires returned showed that No No Liverpool, many stated that they were Liverpool rather than 1.18% 4.86% Good Cancer Services happy with the current service Clatterbridge.” respondents came from the following postcode areas: Fear of loss of services Yes Yes provision at The Clatterbridge Many respondents spoke of the 98.18% 87% Cancer Centre. existing excellent cancer services The loss of services was a concern OTHER - 4.77% Not Not Sure Sure and a preference to keep services in for a particular minority of voters. In 0.64% 8.13% Accessibility Clatterbridge. some cases people felt that the WA - 26.84% proposals might lead to the ultimate The accessibility theme covers issues “No problems with CCC so closure of services and loss of jobs L - 47.3% of transport and travel but also why change?” at Clatterbridge. The themes identified were: includes references to the availability of public and private transport, Respondents also acknowledged “Provided the service currently CH - 21.09% Travel Good Cancer Services parking and congestion. the benefits of the re-location and available at the existing Accessibility Ill health the establishment of a new cancer Clatterbridge site is not Expense Fear of loss of services In general, those people who don’t centre, linked to state-of-the-art diminished in any way then the think the proposals are a good idea cancer research and treatment new proposal is an excellent idea felt that the new centre would reduce facilities. otherwise not so.” Agenda Item 5(B)
PROTOCOL FOR ESTABLISHMENT OF JOINT HEALTH SCRUTINY ARRANGEMENTS FOR CHESHIRE AND MERSEYSIDE
1. INTRODUCTION
1.1 This protocol has been developed as a framework for the operation of joint health scrutiny arrangements across the local authorities of Cheshire and Merseyside. It allows for:
scrutiny of substantial developments and variations of the health service; and, discretionary scrutiny of local health services
1.2 The protocol provides a framework for health scrutiny arrangements which operate on a joint basis only. Each constituent local authority should have its own local arrangements in place for carrying out health scrutiny activity individually.
2. BACKGROUND
2.1 The Health and Social Care Act 2012 and the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 came into effect on 1 April 2013 revising existing legislation regarding health scrutiny.
2.2 In summary, the revised statutory framework authorises local authorities to:
review and scrutinise any matter relating to the planning, provision and operation of the health service; and, consider consultations by a relevant NHS body or provider of NHS-funded services on any proposal for a substantial development or variation to the health service in the local authority’s area.
2.3 Ultimately the regulations place a requirement on relevant scrutiny arrangements to reach a view on whether they are satisfied that any proposal that is deemed to be a substantial development or variation is in the interests of the health service in that area, or instead, that the proposal should be referred to the Secretary of State for Health. In instances where a proposal impacts on the residents of one local authority area exclusively, this responsibility lays with that authority’s health scrutiny arrangements alone.
2.4 Where such proposals impact on more than one local authority area, each authority’s health scrutiny arrangements must consider whether the proposals constitute a substantial development or variation or not. Agenda Item 5(B)
The regulations place a requirement on those local authorities that agree that a proposal is substantial to establish, in each instance, a joint overview and scrutiny committee for the purposes of considering it. This protocol deals with the proposed operation of such arrangements for the local authorities of Cheshire and Merseyside.
3. PURPOSE OF THE PROTOCOL
3.1 This protocol sets out the framework for the operation of joint scrutiny arrangements where:
a) an NHS body or health service provider consults with more than one local authority on any proposal it has under consideration, for a substantial development/variation of the health service;
b) joint scrutiny activity is being carried out on a discretionary basis into the planning, provision and operation of the health service
3.2 The protocol covers the local authorities of Cheshire and Merseyside including:
Cheshire East Council Cheshire West and Chester Council Halton Borough Council Knowsley Council Liverpool City Council St. Helens Metropolitan Borough Council Sefton Council Warrington Borough Council Wirral Borough Council
3.3 Whilst this protocol deals with arrangements within the boundaries of Cheshire and Merseyside, it is recognised that there may be occasions when consultations/discretionary activity may affect adjoining regions/ areas. Arrangements to deal with such circumstances would have to be determined and agreed separately, as and when appropriate.
4. PRINCIPLES FOR JOINT HEALTH SCRUTINY
4.1 The fundamental principle underpinning joint health scrutiny will be co- operation and partnership with a mutual understanding of the following aims:
To improve the health of local people and to tackle health inequalities;
Agenda Item 5(B)
To represent the views of local people and ensure that these views are identified and integrated into local health service plans, services and commissioning;
To scrutinise whether all parts of the community are able to access health services and whether the outcomes of health services are equally good for all sections of the community; and,
To work with NHS bodies and local health providers to ensure that their health services are planned and provided in the best interests of the communities they serve.
5. SUBSTANTIAL DEVELOPMENT/VARIATION TO SERVICES
5.1 Requirements to consult
5.1.1 All relevant NHS bodies and providers of NHS-funded services1 are required to consult local authorities when they have a proposal for a substantial development or substantial variation to the health service.
5.1.2 A substantial development or variation is not defined in legislation. Guidance has suggested that the key feature is that it should involve a major impact on the services experienced by patients and/or future patients.
5.1.3 Where a substantial development or variation impacts on the residents within one local authority area boundary, only the relevant local authority health scrutiny function shall be consulted on the proposal.
5.1.4 Where a proposal impacts on residents across more than one local authority boundary, the NHS body/health service provider is obliged to consult all those authorities whose residents are affected by the proposals in order to determine whether the proposal represents a substantial development or variation.
5.1.5 Those authorities that agree that any such proposal does constitute a substantial development or variation are obliged to form a joint health overview and scrutiny committee for the purpose of formal consultation by the proposer of the development or variation.
5.1.6 Whilst each local authority must decide individually whether a proposal represents a substantial development/variation, it is only the statutory joint health scrutiny committee which can formally comment on the proposals if more than one authority agrees that the proposed change is “substantial”.
1 This includes the NHS England, any Clinical Commissioning Group providing services to the residents of Cheshire and Merseyside, an NHS Trust, an NHS Foundation Trust and any other relevant provider of NHS funded services which provides health services to those residents, including public health. Agenda Item 5(B)
5.1.7 Determining that a proposal is not a substantial development/variation removes the ability of an individual local authority to comment formally on the proposal and exercise other powers, such as the power to refer to the Secretary of State. Once such decisions are made, the ongoing obligation on the proposer to consult formally on a proposal relates only to those authorities that have deemed the proposed change to be “substantial” and this must be done through the vehicle of the joint committee. Furthermore the proposer will not be obliged to provide updates or report back on proposals to individual authorities that have not deemed them to be “substantial”.
5.2 Process for considering proposals for a substantial development/variation
5.2.1 In consulting with the local authority in the first instance to determine whether the change is considered substantial, the NHS body/ provider of NHS-funded service is required to:
Provide the proposed date by which it requires comments on the proposals Provide the proposed date by which it intends to make a final decision as to whether to implement the proposal Publish the dates specified above Inform the local authority if the dates change2
5.2.3 NHS bodies and local health service providers are not required to consult with local authorities where certain ‘emergency’ decisions have been taken. All exemptions to consult are set out within regulations.3
5.2.4 In considering whether a proposal is substantial, all local authorities are encouraged to consider the following criteria:
Changes in accessibility of services: any proposal which involves the withdrawal or change of patient or diagnostic facilities for one or more speciality from the same location.
Impact on the wider community and other services: This could include economic impact, transport, regeneration issues.
Patients affected: changes may affect the whole population, or a small group. If changes affect a small group, the proposal may still be regarded as substantial, particularly if patients need to continue accessing that service for many years.
2 Section 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 3 Section 24 ibid Agenda Item 5(B)
Methods of service delivery: altering the way a service is delivered may be a substantial change, for example moving a particular service into community settings rather than being entirely hospital based.
Potential level of public interest: proposals that are likely to generate a significant level of public interest in view of their likely impact.
5.2.5. This criteria will assist in ensuring that there is a consistent approach applied by each authority in making their respective decisions on whether a proposal is “substantial” or not. In making the decision, each authority will focus on how the proposals impacts on its own area/ residents.
6. OPERATION OF A STATUTORY JOINT HEALTH OVERVIEW AND SCRUTINY COMMITTEE
6.1 General
6.1.1 A joint health overview and scrutiny committee will be made up of each of the constituent local authorities that deem a proposal to be a substantial development or variation. This joint committee will be formally consulted on the proposal and have the opportunity to comment. It will also be able to refer to the Secretary of State for Health if any such proposal is not considered to be in the interests of the health service.
6.1.2 A decision as to whether the proposal is deemed substantial shall be taken within a reasonable timeframe and in accordance with any deadline set by the lead local authority, following consultation with the other participating authorities.
6.2 Powers
6.2.1 In dealing with substantial development/variations, any statutory joint health overview and scrutiny committee that is established can:
require relevant NHS bodies and health service providers to provide information to and attend before meetings of the committee to answer questions make comments on the subject proposal by a date provided by the NHS body/local health service provider make reports and recommendations to relevant NHS bodies/local health providers require relevant NHS bodies/local health service providers to respond within a fixed timescale to reports or recommendations Agenda Item 5(B)
carry out further negotiations with the relevant NHS body where it is proposing not to agree to a substantial variation proposal; and where agreement cannot be reached, to notify the NHS body of the date by which it intends to make the formal referral to the Secretary of State
6.2.2 A joint health overview and scrutiny committee has the power to refer a proposal to the Secretary of State if:
the committee is not satisfied that consultation with the relevant health scrutiny arrangements on any proposal has been adequate it is not satisfied that reasons for an ‘emergency’ decision that removes the need for formal consultation with health scrutiny are adequate it does not consider that the proposal would be in the interests of the health service in its area
6.2.3 Where a committee has made a recommendation to a NHS body/local health service provider regarding a proposal and the NHS body/provider disagrees with the recommendation, the local health service provider/NHS body is required to inform the joint committee and attempt to enter into negotiation to try and reach an agreement. In this circumstance, a joint committee has the power to report to the Secretary of State if:
relevant steps have been taken to try to reach agreement in relation to the subject of the recommendation, but agreement has not been reached within a reasonable period of time; or, There has been no attempt to reach agreement within a reasonable timeframe.
6.2.4 Where a committee disagrees with a substantial variation and has either made comments (without recommendations) or chosen not to provide any comments, it can report to the Secretary of State only if it has:
Informed the NHS body/local health service provider of its decision to disagree with the substantial variation and report to the Secretary of State; or, Provided indication to the NHS body/local health service provider of the date by which it intends to make a referral.
6.2.5 In any circumstance where a committee disagrees with a proposal for a substantial variation, there will be an expectation that negotiations will be entered into with the NHS body/local health service provider in order to attempt to reach agreement.
Agenda Item 5(B)
6.2.6 Where local authorities have agreed that the proposals represent substantial developments or variations to services and agreed to enter into joint arrangements, it is only the joint health overview and scrutiny committee which may exercise these powers.
6.2.7 A statutory joint health overview and scrutiny committee established under the terms of this protocol may only exercise the powers set out in 6.2.1 to 6.2.3 above in relation to the statutory consultation for which it was originally established. Its existence is time-limited to the course of the specified consultation and it may not otherwise carry out any other activity.
6.3 Membership
6.3.1 Each participating local authority should ensure that those Councillors it nominates to a joint health overview and scrutiny committee reflect its own political balance.4 However, overall political balance requirements may be waived with the agreement of all participating local authorities.
6.3.2 A joint committee will be composed of Councillors from each of the participating authorities within Cheshire and Merseyside in the following ways:
where 4 or more local authorities deem the proposed change to be substantial, each authority will nominate 2 elected members
where 3 or less local authorities deem the proposed change to be substantial, then each participating authority will nominate 3 elected members.
(Note: In making their nominations, each participating authority will be asked to ensure that their representatives have the experience and expertise to contribute effectively to a health scrutiny process)
Local authorities who No’ of elected members to consider change to be be nominated from each ‘substantial’ authority 4 or more 2 members 3 or less 3 members
6.3.3 Each local authority will be obliged to nominate elected members through their own relevant internal processes and provide notification of those members to the lead local administrative authority at the earliest opportunity.
4 Localism Act 2011, Schedule 2 9FA, 6 (b) Agenda Item 5(B)
6.3.4 To avoid inordinate delays in the establishment of a relevant joint committee, it is suggested that constituent authorities arrange for delegated decision making arrangements to be put in place to deal with such nominations at the earliest opportunity.
6.4
6.5 Quorum
6.5.1 The quorum of the meetings of a joint committee shall be one quarter of the full membership of any Joint Committee, subject to the quorum being, in each instance, no less than 3.
6.5.2 There will be an expectation for there to be representation from each authority at a meeting of any joint committee established. The lead local authority will attempt to ensure that this representation is achieved.
6.6 Identifying a lead local authority
6.6.1 A lead local authority should be identified from one of the participating authorities to take the lead in terms of administering and organising a joint committee in relation to a specific proposal.
6.6.2 Selection of a lead authority should, where possible, be chosen by mutual agreement by the participating authorities and take into account both capacity to service a joint health scrutiny committee and available resources. The application of the following criteria should also guide determination of the lead authority:
The local authority within whose area the service being changed is based; or The local authority within whose area the lead commissioner or provider leading the consultation is based.
6.6.3 Lead local authority support should include a specific contact point for communication regarding the administration of the joint committee. There will be an obligation on the key lead authority officer to liaise appropriately with officers from each participating authority to ensure the smooth running of the joint committee.
6.6.4 Each participating local authority will have the discretion to provide whatever support it may deem appropriate to their own representative(s) to allow them to make a full contribution to the work of a joint committee.
Agenda Item 5(B)
6.7 Nomination of Chair/ Vice-Chair
The chair/ vice-chair of the joint health overview and scrutiny committee will be nominated and agreed at the committee’s first meeting. It might be expected that consideration would be given to the chair being nominated from the representative(s) from the lead authority.
6.8 Meetings of a Joint Committee
6.8.1 At the first meeting of any joint committee established to consider a proposal for a substantial development or variation, the committee will also consider and agree:
The joint committee’s terms of reference; The procedural rules for the operation of the joint committee; The process/ timeline for dealing formally with the consultation, including:
o the number of sessions required to consider the proposal; and, o the date by which the joint committee will make a decision as to whether to refer the proposal to the Secretary of State for Health – which should be in advance of the proposed date by which the NHS body/service provider intends to make the decision.
6.8.2 All other meetings of the joint committee will be determined in line with the proposed approach for dealing with the consultation. Different approaches may be taken for each consultation and could include gathering evidence from:
NHS bodies and local service providers; patients and the public; voluntary sector and community organisations; and NHS regulatory bodies.
6.9 Reports of a Joint Committee
6.9.1 A joint committee is entitled to produce a written report which may include recommendations. As a minimum, the report will include:
An explanation of why the matter was reviewed or scrutinised A summary of the evidence considered A list of the participants involved in the review An explanation of any recommendations on the matter reviewed or scrutinised
Agenda Item 5(B)
The lead authority will be responsible for the drafting of a report for consideration by the joint committee.
6.9.2 Reports shall be agreed by the majority of members of a joint committee and submitted to the relevant NHS body/health service provider or the Secretary of State as applicable.
6.9.3 Where a member of a joint health scrutiny committee does not agree with the content of the committee’s report, they may produce a report setting out their findings and recommendations which will be attached as an appendix to the joint health scrutiny committee’s main report.
7. DISCRETIONARY HEALTH SCRUTINY
7.1 More generally, the Health and Social Care Act 2012 and the 2013 Health Scrutiny Regulations provide for local authority health scrutiny arrangements to scrutinise the planning, provision and operation of health services.
7.2 In this respect, two or more local authorities may appoint a joint committee for the purposes of scrutinising the planning, provision and operation of health services which impact on a wider footprint than that of an individual authority’s area.
7.3 Any such committee will have the power to:
require relevant NHS bodies and health service providers to provide information to and attend before meetings of the committee to answer questions make reports and recommendations to relevant NHS bodies/local health providers require relevant NHS bodies/local health service providers to respond within a fixed timescale to reports or recommendations
7.4 A discretionary joint committee will not have the power to refer an issue to the Secretary of State for Health.
7.5 In establishing a joint committee for the purposes of discretionary joint scrutiny activity, the constituent local authorities should determine the committee’s role and remit. This should include consideration as to whether the committee operates as a standing arrangement for the purposes of considering all of the planning, provision and operation of health services within a particular area or whether it is being established for the purposes of considering the operation of one particular health service with a view to making recommendations for its improvement. In the case of the latter, the committee must disband once its specific scrutiny activity is complete.
Agenda Item 5(B)
7.6 In administering any such committee, the proposed approach identified in sections 6.3 – 6.9 (disregarding any power to refer to the Secretary of State) of this protocol should be followed, as appropriate.
Agenda Item 5(B)
8. CONCLUSION
8.1 The local authorities of Cheshire and Merseyside have adopted this protocol as a means of governing the operation of joint health scrutiny arrangements both mandatory and discretionary. The protocol is intended to support effective consultation with NHS bodies or local health service providers on any proposal for a substantial development of or variation in health services. The protocol also supports the establishment of a joint health overview and scrutiny committee where discretionary health scrutiny activity is deemed appropriate.
8.2 The protocol will be reviewed regularly, and at least on an annual basis to ensure that it complies with all current legislation and any guidance published by the Department of Health.
Agenda Item 6
WARRINGTON BOROUGH COUNCIL
SCRUTINY COMMITTEE – 23 July 2014
Report of: Cllr Tony Higgins, Chairman of the Scrutiny Committee Report Author: Julian Joinson, Principal Democratic Services Officer Contact Details: Email Address: Telephone: [email protected] (01925) 442112 Ward Members: All Wards
TITLE OF REPORT: Work Programme 2014/15 and Monitoring of Actions/Recommendations 2013/14 – 2014/15
1. PURPOSE
1.1 The purpose of the report is for the Committee to consider its Work Programme for 2014/15 and to monitor any actions and recommendations agreed by the Committee or any of its Working Groups.
2. CONFIDENTIAL OR EXEMPT
2.1 This report is not considered to contain information which is confidential or exempt.
3. INTRODUCTION AND BACKGROUND
3.1 The Committee agreed a draft Work Programme for 2014/15 at its meeting on 19 March 2014, including some topics which would be rolled forward from the Work Programme for 2013/14. Since March further work has been undertaken to consider the proposed topics and to identify new ideas for the Work Programme.
3.2 This report contains details of the further work that has been undertaken and, where available, the business case for inclusion of a specific topic. It is acknowledged that additional work will be required for some of the topics to identify the type of engagement activity appropriate for the Committee, desired outcomes and likely timescales. A draft work programme is proposed and attached at Appendix 1.
3.3 As in the previous year, it is suggested that the Work Programme contain a mixture of:-
annual reports from higher risk Council services and from public and voluntary sector partners; information about the public sector finances and the development of the Council’s budget;
Agenda Item 6
external inspection reports in relation to OFSTED, CQC and other relevant bodies; Statutory and non-statutory health scrutiny, including any reports and referrals form Healthwatch, prposals for substantial developments or variations of health services, comments on Quality Accounts, and engagement with Health and Wellbeing Board, NHS commissioners and providers; In-depth reviews (as appropriate).
3.4 Members of the Committee will also have access to routine budget and performance monitoring information for the Council outside of the formal meeting setting, but may ask for a question on any such matter to be included on an Agenda, as appropriate.
3.5 The following topics are suggested for inclusion in the Work Programme 2014/15:-
Council and Partners Annual Reports
Youth Strategy Forum Annual Report; Warrington Partnership Annual Update; Combined Children’s and Adults’ Complaints Annual Report; Educational Achievement – Annual Report; Council’s Active Warrington Strategy and LiveWire Annual Report; Cultural Strategy and Culture Warrington Annual Report; Annual Report on Adult Safeguarding; Annual Report on Children’s Safeguarding; Healthwatch Warrington Annual Report; Local Enterprise Partnership;
Finances and Budget
National spending plans and local pressures; Scrutiny of the Medium Term Financial Plan and Council’s Budget;
Inspection Reports
CQC updates; OFSTED reports;
Health Scrutiny
Transforming Cancer Care – decision as to if this is a substantial variation for Warrington and progress reports form Joint HOSC; State of Warrington Report - snapshot of progress as to Health and Wellbeing targets; Healthwatch Warrington Updates/Referrals; NHS Quality Accounts;
Agenda Item 6
NHS Substantial Variation/Development of Service – Consultations; Engagement with Health and Wellbeing Board, NHS commissioners and providers;
In-Depth Reviews
Homelessness Review (CfPS project).
3.6 The schedule at Appendix 2 provides an update as to progress on any actions proposed or recommendations made by the Committee, referrals received, and Working Group recommendations.
4. WORKING GROUP ACTIVITY
4.1 The Committee has not established any Working Groups. A project with the Centre for Public Scrutiny around homelessness, established under the auspices of the former Neighbourhood and Communities Overview and Scrutiny Committee, has yet to report back and may be taken forward by this Committee.
5. FINANCIAL CONSIDERATIONS
5.1 When carrying out scrutiny activity Members are reminded of the general financial climate and the Council’s Values, which include a commitment to “living within our means.”
6. RISK ASSESSMENT
6.1 The following potential risks have been identified: recommendations not accepted by Executive Board, or not acted upon; partners unwilling to engage; insufficient capacity within Directorates to support scrutiny activity in the light of efficiency savings; selection of inappropriate topics, which have minimal impact or are undeliverable; insufficient capacity within the work programme to deal with matters arising.
6.2 Risks are regularly monitored and managed by the Chairman with the advice and support of relevant officers. Links with the Partnerships and Performance Team and the Policy Committees are maintained and the delivery of the Work Programme is routinely monitored.
7. EQUALITY AND DIVERSITY/EQUALITY IMPACT ASSESSMENT
7.1 Democratic and Member Services has an up to date Equality Impact Assessment for its policies and services.
7.2 Equalities issues relating to policies, services and other topics under scrutiny are the responsibility of the individual Directorates concerned. However, the committee will monitor the compliance by Directorates on equality and diversity issues when carrying out its functions.
Agenda Item 6
8. CONSULTATION
8.1 Consultation with relevant stakeholders is undertaken on a regular basis.
9. RECOMMENDATION
9.1 To approve the draft Work Programme for 2014/15 at Appendix 1 and request officers in consultation with the Chair of the Committee, to refine this document for consideration at the Committee’s meeting on 24 September 2014;
9.2 To note the progress on actions, recommendations and referrals at Appendix 2.
10. BACKGROUND PAPERS
Nil
Contacts for Background Papers:
Name E-mail Telephone Julian Joinson [email protected] 01925 442112
Agenda Item 6 – Appendix 1
23 July 2014 REPORT DEADLINE – MONDAY 14 JULY 2014 Issue Methodology, Details, Purpose Lead Progress Further Officer(s) Action(s) Transforming Rationale: To consider whether the proposals by Cheshire and Merseyside J Joinson Regular Cancer Care CSU and Clatterbridge Cancer Centre NHS Trust constitute a substantial reports as to variation or development of service and to finalise arrangements for the NHS England progress by establishment of a Joint HOSC with other affected authorities in the region and 5BPT the HOSC
Anticipated Outcome: To engage the public and service users and to provide challenge to health service commissioners and providers about significant changes to Cancer Care to ensure that outcomes are in the interests of local health services. North West Rationale: To receive a presentation on the Five year Business Plan of NWAS Ambulance NWAS to understand issues how this might impact upon local ambulance, Service – Good to passenger transport and helpline services. Great: Five year Business Plan Anticipated Outcome: To provide critical challenge to a partner health body on the service delivered across the region and locally.
24 September 2014 REPORT DEADLINE – MONDAY 15 SEPTEMBER 2014 Issue Methodology, Details, Purpose Lead Progress Further Officer(s) Action(s) Transforming Rationale: To receive an update on the work of the Joint HOSC dealing J Joinson Cancer Care with the proposals by Cheshire and Merseyside CSU and Clatterbridge Cancer Centre NHS Trust on the Transformation of Cancer Care.
Anticipated Outcome: To engage the public and service users and to provide challenge to health service commissioners and providers about significant changes to Cancer Care to ensure that outcomes are in the interests of local health services.
Progress Legend Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed Issues (exception)
Agenda Item 6 – Appendix 1 Homelessness Rationale: To consider a report on New Homeless produced following a Dr R Review (CfPS project with the Centre for Public Scrutiny looking at health scrutiny with a Robertson project); Return on Investment approach.
Anticipated Outcome: To make a report and recommendations to the Executive Board on potential improvements to housing advice services for working families who have been affected adversely by the economic downturn and are at risk of homelessness. Youth Strategy Rationale: To receive an update report from the Youth Strategy Forum on F Waddington Forum Annual its partnership activity in respect of young people in Warrington Report Anticipated Outcome: To provide critical challenge to partnership bodies about the delivery of multi-agency plans across Warrington.
Warrington Rationale: To receive an update report from Warrington Partnership as to K Griffiths Partnership progress on the delivery Partnership priorities. Annual Update Anticipated Outcome: To provide critical challenge to partnership bodies about the delivery of multi-agency plans across Warrington and to provide assurance to the public that the Council is leading on ‘place shaping’. Combined Rationale: To receive an annual report on the numbers and types of Social Rick Howell Children’s and Care complaints received. This will be the first year that Children’s Social Adults’ Care and Adult Social care complaints have been brought together within Complaints the Families and Wellbeing Directorate and reported together. Annual Report Anticipated Outcome: To provide an assurance to service users that complaints are treated seriously and to identify any significant learning points or systemic failures which need to be addressed. Healthwatch Rationale: To consider the annual report from Healthwatch, including its Helen Speed Warrington findings in relation to the customer or patient experience of healthcare or Annual Report adult social care in Warrington.
Anticipated Outcome: To gather intelligence from service users about the standards of health care and adult social care in Warrington and to make
Progress Legend Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed Issues (exception)
Agenda Item 6 – Appendix 1
reports or recommendations to providers, as necessary.
12 November 2014 REPORT DEADLINE – MONDAY 3 NOVEMBER 2014 Issue Methodology, Details, Purpose Lead Progress Further Officer(s) Action(s) National Rationale: To receive a report to coincide with the Chancellor’s Autumn L Green and spending plans statement to provide an early indication of external and internal financial Portfolio and local pressures on the Council’s future Budget Holder for pressures Corporate Anticipated Outcome: To provide early context to the Committee about the Resources & financial environment prior to its in depth consideration of the draft Budget Assignments in January. Transforming Rationale: To receive an update on the work of the Joint HOSC dealing J Joinson Cancer Care with the proposals by Cheshire and Merseyside CSU and Clatterbridge Cancer Centre NHS Trust on the Transformation of Cancer Care.
Anticipated Outcome: To engage the public and service users and to provide challenge to health service commissioners and providers about significant changes to Cancer Care to ensure that outcomes are in the interests of local health services. State of Rationale: To receive a biannual high level monitoring report, also Dr R Warrington provided to the Health and Wellbeing Board, which includes overarching Robertson Report outcome measures for performance in the five thematic priority areas of the Warrington Strategy for Wellbeing (JHWS)
Anticipated Outcome: To provide critical challenge to the Health and Wellbeing Board and an assurance to the public that health and wellbeing priorities are being met. Annual Report on Rationale: To consider an annual report on Adult Safeguarding and the S Reddy Adult Safeguarding Board’s Business Plan. Safeguarding Anticipated Outcome: To hold to account the executive and partners
Progress Legend Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed Issues (exception)
Agenda Item 6 – Appendix 1
regarding arrangements for the protection of a specific vulnerable group and to provide an assurance to service users and their families about safeguarding issues.
Annual Report on Rationale: To consider an annual report on Children’s Safeguarding and F Waddington Children’s the Safeguarding Board’s Business Plan. Safeguarding Anticipated Outcome: To hold to account the executive and partners regarding arrangements for the protection of a specific vulnerable group and to provide an assurance to service users and their families about safeguarding issues
21 January 2015 REPORT DEADLINE – MONDAY 12 JANUARY 2014 Issue Methodology, Details, Purpose Lead Progress Further Officer(s) Action(s) Scrutiny of the Rationale: To respond to the annual consultation on the MTFP and draft L Green and Medium Term Council Budget Portfolio Financial Plan Holder for and Council’s Anticipated Outcome: To support the Executive Board and Council to Corporate Budget develop a robust Budget which is aligned to Corporate priorities and to be Resources & a voice for comments and concerns expressed by the public and other Assignments stakeholders. Educational Rationale: To receive a report on the educational achievement of pupils in S Callaghan Achievement – Warrington and the performance of Warrington schools, including Annual Report Academies and Free Schools.
Anticipated Outcome: To hold to account providers of publicly funded education in Warrington so as to help drive up educational attainment by Warrington pupils.
18 March 2015
Progress Legend Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed Issues (exception)
Agenda Item 6 – Appendix 1
REPORT DEADLINE – MONDAY 9 MARCH 2014 Issue Methodology, Details, Purpose Lead Progress Further Officer(s) Action(s) State of Rationale: To receive a biannual high level monitoring report, also provided Dr R Warrington to the Health and Wellbeing Board, which includes overarching outcome Robertson Report measures for performance in the five thematic priority areas of the Warrington Strategy for Wellbeing (JHWS)
Anticipated Outcome: To provide critical challenge to the Health and Wellbeing Board and an assurance to the public that health and wellbeing priorities are being met. NHS Quality Rationale: To receive any presentations from NHS providers about their WHHT, Draft Quality Accounts annual Quality Accounts. Draft Quality Accounts will usually be circulated 5BPT, Accounts outside of the formal meetings for Members’ comments. Bridgewater should be NHS Trust, available from Anticipated Outcome: To respond NHS bodies carrying out their statutory Clatterbridge March 2014. duty to consult Scrutiny, by holding NHS bodies to account for past Cancer Trust, Replies are performance and providing a conduit for the public to comment on future NWAS usually priorities. delegated to officers in consultation with the Chairman Council’s Active Rationale: To receive a report on the delivery of the Council’s Active S Kenton Warrington Warrington Strategy, including an annual report on the performance of Strategy and LiveWire, which shows past performance and future priorities for the Trust. LiveWire Annual To be considered in conjunction with the Supporting the Local Economy Report Policy Committee.
Anticipated Outcome: To hold to account the principal provider of leisure services in Warrington and to provide an assurance to the public about standards of service. Cultural Strategy Rationale: To receive a report on the delivery of the Council’s Cultural S Kenton
Progress Legend Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed Issues (exception)
Agenda Item 6 – Appendix 1 and Culture Strategy, including an annual report on the performance of Culture Warrington Warrington, which shows past performance and future priorities for the Annual Report Trust. To be considered in conjunction with the Supporting the Local Economy Policy Committee.
Anticipated Outcome: To hold to account the principal provider of cultural services in Warrington and to provide an assurance to the public about standards of service. Local Enterprise Rationale: To commence engagement with the Cheshire and Warrington A Farrall Partnership Enterprise Partnership. This is partnership between the local authority and businesses. It decides what the priorities should be for investment in roads, buildings and facilities in the area.
Anticipated Outcome: To understand the role of the Partnership and to build a relationship between the LEP and Scrutiny to work towards being in a position, in cooperation with the 2 Cheshire unitary authorities, to hold to account the partnership for the planning and co-ordination of economic development in the sub-region.
Progress Legend Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed Issues (exception)
Agenda Item 6 – Appendix 1
Work Programme Items (Not yet allocated to a meeting) Issue Rationale Anticipated Timescale CQC updates Rationale: To consider on a quarterly basis a summary of CQC inspection reports in relation to An care provided in Warrington. To be local watchdog for any good and poor standards involving appropriate providers, so as to provide a conduit for intelligence from service users and other stakeholders to reporting be fed back CQC. system needs to be Anticipated Outcome: To hold local providers of care to account and to engage with the public developed to about their experiences of care provision. capture CQC (S Reddy) information and WBC support OFSTED reports Rationale: To consider any reports of the Inspectorate in respect of the Council or educational provision in Warrington and any Action Plans arising.
Anticipated Outcome: To provide assurance to the public that procedures are in place to learn from the findings of inspections to improve educational provision in Warrington. (F Waddington) Healthwatch Rationale: To consider update reports from Healthwatch, including its findings in relation to the Warrington customer or patient experience of healthcare or adult social care in Warrington. To deal with any Updates/Referrals statutory referrals from Healthwatch.
Anticipated Outcome: To gather intelligence from service users about the standards of health care and adult social care in Warrington and to make reports or recommendations to providers, as necessary. (Helen Speed) NHS Substantial Rationale: To deal with any health service matters which in the view of the Committee constitute a Variation/Development substantial variation or development of service. NB. Later Life Memory Services may be the of Service – subject of a Consultation by 5BPT. Consultations Anticipated Outcome: To engage the public and service users and to provide challenge to health service commissioners and providers about significant changes to services to ensure that outcomes are in the interests of local health services. (NHS England, WCCG and other NHS bodies, as appropriate)
Agenda Item 6 – Appendix 1
Engagement with Rationale: To continue engagement activities with the NHS England, Public Health England, Health and Wellbeing Warrington CCG, the Health and Wellbeing Board, local authority public heath services and Board, NHS providers of primary care service in Warrington. To receive updates from health sector partners commissioners and as and when issues arise which are significant, but not substantial matters covered by statutory providers and other health scrutiny consultation. (NHS England, PHE, WCCG, HWB, Director of Public Health and other NHS bodies, as health partners appropriate)
Agenda Item 6 – Appendix 2
Monitoring of Recommendations & Actions
A. Committee Recommendations and Actions
These are items that have come directly from an item on the Agenda of a meeting of this Committee
Minute No Recommendation Referred to Action Progress & Date & Date SC20 The Francis Inquiry into Mid Staffordshire NHS 24/06/13 Foundation Trust – Messages and Implications
(2) To approve the Action Plan at Appendix 1; T Date Detailed work yet to 25/06/13 commence
SC21 Health Scrutiny in Warrington – Legacy Report 24/06/13 (3) To approve the Action Plan at Appendix 2 and to monitor T Date Detailed work yet to progress from time to time; 25/06/13 commence
SC52 New Cut Heritage and Ecology Trail 19/03/14 An undertaking was given (Informally) to monitor the way that T Date To be followed up in partners worked together to maintain and develop the Trail for the 20/03/14 March 2015 future SC57 Protocol for the Establishment of Joint Health Scrutiny 19/03/14 Arrangements for Cheshire and Merseyside Approved by Council on 9 June 2014, with (3) To approve to the Protocol for the Establishment of Joint T Date minor amendment to Health Scrutiny Arrangements for Cheshire and 20/03/14 rules about HOSC Merseyside, as set out at Appendix A; and membership
Agenda Item 6 – Appendix 2
(4) To approve, as part of its annual process for making T Date Political appointments to committees, the appointment of 3 elected 20/03/14 appointments to members (ranked in order subject to the political balance seats agreed at rules), for allocation to any Joint Health Overview and Annual Council on 9 Scrutiny Committee established under the Protocol; June 2014
Agenda Item 6 – Appendix 2
B. Referrals to the Committee
These are items that have been formally referred to the Committee by another body, such as Council, the Executive Board or another Committee
Referred Minute Details Response/Comments Progress from and Date Nil
C. Working Group Final Report Recommendations
When a Working Group has submitted its final report and recommendations to the relevant body a summary will be recorded in the table below. Where interim recommendations are made prior to a final report, these are also recorded here.
Recommendation Referred Action Review Date Progress to and Date Nil
Agenda Item 6 – Appendix 2
D. Schedule of Future Meeting Dates
Meeting Dates Where possible, draft documentation to Final documentation to be provided no later than be provided no later than
2014 23 July 7 July 14 July
24 September 8 September 15 September
12 November 27 October 3 November
2015 21 January 5 January 12 January
18 March 2 March 9 March