Notes Friday 18 October 2019 – 9.30an – 11.30am The Oval Centre, Salterbeck Drive, Salterbeck, Workington Attendees: Richard Pratt, Julie Clayton, Liz Clegg, Jon Ward, Chris Shaw, Carole Woodman, Keith Amey, Jane Smith, Martin Adair, Julie Clayton, Rhia Heron, Yvonne Fairburn, Neil Hughes, John Ward, Val Ayre, Eric Urqhuart, Eileen Turner, Alan Alexander, Jayne Gilbert, Jennie Peall, Steve Thoburn, Julie Lawlor, Chris Kitchen, Keith Amey, Sean Linford, Nick Ford, Robin Talbot, John Howarth, Elaine Ralph (notes) Apologies: Sue Stevenson, Stephen Eames, Stephen Singleton, Mahesh Dhebar, Sue Hayman, Jon Rush, Christine Wharrier, Gilda Wells 1 Welcome and Introductions Richard Pratt welcomed everyone and introductions and apologies were made. 2. Notes from the last meeting Notes agreed 3. West Cumberland Hospital (WCH) Update – John Howarth – North Cumbria Integrated Care NHS Foundation Trust Phase 2 of the WCH redevelopment includes old buildings removal – this has cost £4.5 million for demolition works. Most of the buildings to come down are now empty – this will take place from November 2019 until August 2020. The investment in the new building is more efficient than keeping the old buildings. E Block will be refurbished as part of the investment. Phase 3 will include the building of 130 student rooms to house the University of Central Lancashire (ULCAN) medical school which will be onsite. There will be an increasing numbers of courses including Physician Associates, Masters and pre-medical courses for those who do not have the right qualifications for medical school. The west site will have the investment of a new teaching centre. It will be a challenge to get the capital to keep the teaching centre running but we are meeting to agree long-term commitments and how it will be funded. There is a WCH Development Steering Group, which includes community representatives. The new design will have to fit the right clinical model for the future. There will be a redesign of the urgent care pathway in the hospital; focussing on the first 12 hours of admittance for patients in order to get people treated as soon as possible in the one place. There are now GP’s on site in the Primary Care/Health centre with specialist outpatients departments – a “One stop shop”. This will be suitable for as many patients as possible. This will help sustain A & E and we hope that our remote and rural hospital will be an exemplar for the future. We will be looking at how urgent and integrated care can work on one floor as a one stop assessment and amongst this we will be looking at how to assess the high risk population in order to treat efficiently. Member: I hope that you are spending the money wisely – we want to be a nursing care exemplar at the WCH. John H – Nursing recruitment is a big challenge in West Cumbria – we have managed to recruit a number of Doctors, not at full capacity but better than we were. Member: you are doing a good job but what about the Allied Health ProfeSsionals (AHP) – are they considered in the new set up? And even if you are looking at high risk patients for assessment purposes, such as the frail and elderly, we have to include younger people who may have several health conditions. John H – Agree the voices of the nurses and the health professionals needs to be loud in order to design the model of a one team approach. We haven’t got the young voice in the restructure of WCH yet. Member: We need to engage with younger people, especially around digital health when building for the future. We need to be digitally able and clinicians need the tools to do so. John H – we should invite Mark Jones to the Forum to talk about digital services. Member: How does the “One Stop Shop” work? John H – example of someone who goes to GP and GP would be able to get realtime advice from a specialist rather than have to email or send referral to specialist, can take days and weeks for response. Can go straight to specialist, i.e. ENT if ear problem rather than refer. There are also digital aids, such as a gadget which can look at a mole, then email to specialist and they can determine the type of mole it is – cutting out processes (LEAN) model. Chair – Are we co-producing this with patients? Co-production is essential to get the patient’s view – what does it feel like for the patient? John H – We have included the Steering Group which has community voices but we need to get more people involved. Julie C– come to the event at Whitehaven “A conversation about our NHS” and people will have the opportunity to talk about this. Member: what does the community want? What about buses to get there? There was a bus mentioned to get from WCH to Cumberland Infirmary Carlisle but that disappeared. Chair – Yes, a patient has a wider point of view and experience of getting to a health appointment/hospital. John H – how do we get a broader view of what the patients want – workshops? We need to listen to staff. Member: we need to get the new governors of the merged Trust involved. John H – yes, agree, we need to be open and try to get it right. Chair – thank you. 4. North Cumbria ICS update – John Howard, NCIC The merger has taken place – it was relatively straightforward. There were four conditions to the merger: 1. Well-led review within six months 2. Quality Improvement 3. Cultural and Organisational journey 4. Financial regulation We recognise we have a long way to go. Looking after our staff is the biggest priority – need to deliver of financial obligations (reducing deficits). If we continue to reduce then we will get money to invest. Member: Is this within NCIC and not the ICS (which includes the North East)? John H – Yes, just north Cumbria. Transfer of Mental Health and Learning Disability Services went well. CNTW have been a fantastic partner. Very much integration at service and leadership level. Hyper Acute Stroke Unit (Cumberland Infirmary Carlisle) – a briefing was sent round to the Forum on Monday. The new Cancer Centre at CIC will be a fantastic new build, which has started. EU Exit – lots of planning around this and winter challenges. Julie Lawlor: We have been working with staff to make them welcome and look to doing something different and spending time normalising services for patients. There is still lots to do. We want to be involved in groups/forums like this to understand how services need to develop in North Cumbria. Member: One way would be to get involved with the SEND workshops (Special Educational Needs and Disability) Julie C – can contact Julie Lawlor about this. Member: We need to understand how Patient Pathway works with those out of area services, i.e. North East. John H – This is up to us to do – we need to expand co-production and get views around the Integrated Care Partnership. Julie C – There are some co-production conversations involving communities planned which link up with our community networks – looks at patients who have to travel a long way for services. Will share information with Forum (11-15th November, Penrith, Maryport, Workington, Whitehaven and Carlisle) 5. Jennie Peall – NWAS 111 service NWAS is the commissioned provider of the 111 service. Recognise there needs to be more community engagement on how the 111 service works. Currently at 75% target for answering calls within timeframe. This does depend on what time of the day you call. We are developing a Mental Health option, to take away some of the pressure on A & E. The health advisors (HA) are trained for 6 weeks on the NHS pathways tool, which is a risk averse tool. This is a non-clinical advisor – it would not be possible to have a clinical advisor answer every call but there will be a clinical advisor in the room or they can transfer the caller to one. The pathway can be a lengthy process - it is a triage system for non-emergencies. It is useful for those who are not registered with a GP in the area (visitors from out of area). Future developments – direct booking of out of hours appointments (i.e. Fellview Surgery) – there will be a number of ring-fenced appointments and Workington Out of Hours and Maryport Out of Hours availability will be extended. Member: some people think that they just google the symptoms. Jennie – No, not true. Member: I think it is a brilliant service. Is it the same as 999 triage? Jennie – no, it is a different triage system – if it is an emergency then they will be sent to the 999 system to be triaged. 111 works with difference pockets of service – not completely joined up with emergency services yet and separate from NWAS but will ultimately join up. Jayne Gilbert – Clinicians on the road can access ICC hub services. Member: Will referrals be audited? Jennie – the 111 process is audited and the HA are audited. Member: What about whether the referral was appropriate? Jennie – We do get feedback from learning forums, county leads to ensure that we are appropriately referring. Member – is there a dental option? Jennie: There is an option for dental care. Member: is it always available? Jennie – it does depend on the time of day and whether there is a dental service available. Member: looking at the symptoms on the 111 online service, a woman’s heart attack symptoms may be different from a man’s – would that be picked up? Jennie – It wouldn’t be possible to put all symptoms on the website, but only the main ones.