STP to outline forward plan and proposed implementation timetable

The STP representatives gave a presentation which included:

·           How the decisions of the Joint CCG Committee had been communicated;

·           The Governance processes being put in place for the continued oversight and implementation of the decisions made;

·           The Membership and Terms of Reference for the Implementation Oversight Group;

·           The establishment of a People’s Panel for on-going engagement with residents on the service changes in relation to Orsett Hospital and to provide an independent view on service relocation. Members of the Panel will be representative of groups within the community;

·           The Transport Working Group for patient, family and a carer transport (which had been established during the consultation) continuing its detailed work looking at existing transport links, and opportunities to enhance access between urban centres and hospital sites;

·           Work had commenced with ECC Integrated Passenger Transport Unit to engage with transport operators to look at the amendment of existing public transport routes to facilitate improved access between hospital sites, and consideration of the development of a shuttle service to run between the three hospitals;

·           A single workforce strategy which was now agreed across the three trusts. An example of the work going on across the three hospitals to resolve workforce shortages was the significant focus being placed on the training and use of apprentices.

The Committee asked the representatives of the STP a number of questions and points of clarification arising from the presentation:-

Stroke services

It was confirmed that the proposals for stroke services were not following the national model and approved pathway. Instead, all patients would be scanned and assessed initially at their local A&E and be eligible for thrombolysis delivered in A&E as was currently done. Once that treatment had started and the patient stabilised they would be transferred to Basildon Hospital for specialist treatment and care before being transferred back to their local hospital in due course if the specialist treatment was successful.

Members asked for reassurance about quality of treatment being maintained for stroke services that were to be relocated. It was confirmed that the project lead for the relocation was the lead clinician at Southend Hospital. Some locums were currently being used and future sustainability of services would be assisted by bringing the stroke teams together at one location.

Clinical transfers

Existing transfers of patients between mid and south Essex’s acute hospitals were believed to be at least 14 per day (primarily cardiology, burns, maxillofacial, burns and ENT patients) and the 15 anticipated additional patients being transferred would increase the total number to 29. An initial 24-hour audit of new transfer numbers had been undertaken. A further two-week audit was now being planned for September.

The STP were exploring an option for a pilot treat and transfer service which could be subsequently refined although timing for the pilot had not been finalised yet. Treat and Transfer would have its own dedicated service with a single command centre for the three hospitals to identify bed need and allocate beds in a timely manner so that the patient did not have to be navigated through another A&E process at the other hospital. Treat and transfer pilot would initially look at those patients already being transferred daily (essentially ENT surgery and cardiology) with the first reconfigured services likely to be vascular, orthopaedic and urology.

Consent would be needed for a clinical transfer and if this was withheld then the patient would be treated as best as could be done at the hospital at which they had presented.

The STP would be looking at providers (including but not exclusively the East of England Ambulance Service) who could provide the clinical transfer services. The example of St John’s Ambulance Service already providing neo natal transfers was given.

Mental health

Hospitals were continuing to work with EPUT to improve A&E mental health assessment times and any admissions into assessment units. It was suggested that this could be an issue for JHOSC to look at.

Orsett Hospital

The STP confirmed that the current services provided at Orsett that were used by Thurrock residents would be relocated and remain within Thurrock area. Those services currently at Orsett and used by people from Basildon and Brentwood may be moved to those areas. Some Members stressed that the STP should continue to listen about the concerns being raised by residents in relation to the Orsett proposals and provide reassurance for them. Timings for the relocation of services would be ‘worked-through’ with the People’s Panel. There would also be a role for the Thurrock HOSC in overseeing the relocation of services and the ongoing role of Orsett Hospital.

Recruitment and staffing

There had been no target recruitment figures for the current year. Instead, there was a rolling recruitment programme. There was also ongoing work to further develop opportunities for other junior staffing levels to see if they can jump in at an appropriate stage in the training to expedite the training process.

Although a specific impact assessment had not been undertaken for Brexit (particularly in relation to meeting workforce requirements) the three hospital trusts had provided a deliverability statement and staffing model as part of the STP plans and an assessment of their ability to meet it. Further information on this modelling could be provided for the JHOSCs themed meeting on financial sustainability and workforce scheduled for later in the year.

There were ongoing discussions with staff about their options for relocating. The hospitals were looking at more 'blended' rotas for some staff combining learning further specialist skills with core components of their existing job. If staff were unable to relocate to other sites then hospitals would explore other options for them and make reasonable adjustments for transport options and working hours.

Localities

Each CCG would have a detailed Primary Care plan to relieve pressure on the acute hospitals. The JHOSC could have a separate session on the overall strategy although local implementation plans would be reviewed by local HOSCs.

At the prompting of Members, the STP agreed to provide more information on the leading edge localities’ that would be ready to move at pace.

Public consultation and Implementation

Detailed timings for implementation of the changes in services would only be developed once there was certainty about capital funding which could be impacted by any referrals to the Secretary of State by the constituent members of the Joint HOSC.

In response to a question about the adequacy of the public consultation asked by a councillor (who was not a member of the Joint Committee but who had been invited to speak by the Chairman) the STP viewed that public feedback received had been duly considered by the STP and the CCG Joint Committee and that there had been an independent Clinical Senate process also reviewing the proposals.

There were not People’s Panels in all areas. However, there were service user advisory groups for the STP. The STP agreed to look further into the suggestion to include families and carers in these groups.

Resolved:-

That the STP be thanked for the presentation and update on the consultation and their next steps.