Calderdale CCG and Greater Huddersfield CCG Governing Bodies meeting in parallel Findings from consultation and deliberation and next steps
Introduction • Background • Deliberation • Purpose • What we considered • Findings • Full Business Case • Recommendation
Background The Governing Bodies have agreed • No change is not an option • To adopt a phased approach • The Clinical Model of Care • Appraisal criteria • Significant financial implications • Clear mandate for consultation • Sufficient change to consult on Phase 2 • Consult on Ph2 and Ph3 at same time
Background • The Consultation has finished • Received • Report of Findings • Equality & Health Inequalities Impact Assessment • Joint Health Scrutiny Response • Healthwatch Response • Consultation Institute sign off
Deliberation • Purpose & Context • What we considered • Report of Findings & Stakeholder Event • Equality and Health Inequality • Joint Health Scrutiny & Healthwatch • NHS England Assurance • Recommendations from deliberation
Deliberation Purpose To enable the CCGs to: • give proper consideration to the response to the public consultation • discharge their duties and obligations, including those in relation to Equalities and Health Inequalities
Deliberation Context • Consultation mandate • CCGs’ Patient Eng & Exp Strategy • NHS Act 2006 • Gunning Criteria • The Equality Act 2010 • The Brown Principles • Health and Social Care Act 2012
Consultation Mandate Sets out: 1. Purpose of Consultation 2. Parameters of Consultation 3. How people will influence the proposals 4. How the findings will be considered
Independent Report of Findings • Considered: • 7582 Surveys • 40,000 comments to 11 open questions • 500+ phone calls, letters, docs, texts & emails • 195 pages of transcripts – 3 public meetings • 10 vox pox • 8 petitions
What did people tell us Do you think you will be negatively affected by our proposed changes? Question 10 Don’t Yes % No % Know % Greater 80 12 7 Huddersfield Calderdale 33 47 20 Overall 67% of all respondents stated they would be negatively affected by the proposed changes
What did people tell us Overall after reading the document do you agree or disagree with our proposed changes? Question 12 Neither Agree % Disagree % Agreed or disagreed % Greater 7 79 11 Huddersfield Calderdale 47 28 22 Overall 64% of all respondents said they disagreed with the proposals
What did people tell us Six Focus Areas • Travel and Transport • Clinical Safety and Capacity • The rationale for change • The consultation process • Understanding the proposed model • The need for change
What did people tell us Travel and Transport • Increased time in an Emergency • Congestion on A629 • Public Transport – Access and Cost • Parking at CRH • Demand on the Ambulance Service
What did people tell us Clinical Safety • Impact of travel on mortality • How will it work in practice • Mainly Urgent/Emergency relationship Capacity • Beds, Staff & impact on other areas
What did people tell us The Rationale for Change • Driven by finance • Influenced by the PFI • How will it be funded • Value for Money • Support from clinical staff
What did people tell us The Consultation Process • Single Option • Language and clarity of material • How was option developed & what evidence • From Staff – want to be involved
What did people tell us Understanding the proposed model • Possibly not fully understood • How it will work in practice • Emergency Care in both towns • Understanding of terms: • Emergency Care • Urgent Care
What did people tell us The need for change • Acknowledge the need for change • Alternatives & Improvements • Configuration • Services • Proposals overall • Existing structure unsustainable
What did people tell us Service Areas • Emergency Care • Urgent Care • Planned Care • Maternity Services • Paediatric Care • Community services
What did people tell us Emergency Care • Travel times and Access • Resources, Staffing and Demand • Mortality and Waiting times • Keep Emergency in Huddersfield • Bed Capacity • Consultation Process
What did people tell us Urgent Care • Location less of a concern • How will it work in practice • Confidence in NHS111 • GP Capacity • Staff levels and skills • Access to right staff and care
What did people tell us Planned Care • Fewer concerns • Calderdale more in favour • Travel • What if Emergency Care is needed • How will proposals be funded
What did people tell us Maternity services • Provision in Community • Patient Experience of care • Understaffing • Personal Care budgets • Privatisation
What did people tell us Paediatric Care • Speed of treatment • Ability to travel • Confidence in NHS111 • GP Capacity • Staff levels and skills • Waiting times and Access
What did people tell us Community services • Access and Waiting times • GP Capacity • Staffing • Finance – cuts in community
Stakeholder Event Findings Summary: 1. Acknowledge people’s contribution to the consultation 2. Clarify for people why the proposals have been put forward 3. Inform people about what is being proposed 4. Establish more detailed information about how the proposals could work Full Report published on the Right Care website
Equality and Health Inequalities Impact Assessment - considerations Equality • The Equality Act 2010 • The CCGs’ Equality Strategies • The public sector equality duty • the Brown Principles; Health Inequalities • The NHS Constitution • The NHS Act 2006
Equality and Health Inequalities • ensure that the proposals would not have any unlawful consequences for people who live or work in our communities. • Consultation • Prior - Equality Impact Assessment • During - Regular review • Post - Equality and Health Inequalities Impact Assessment (EHIIA) • Continuing Duty
EHIIA Findings • Nothing found amounting to unlawful discrimination • The proposals are intended to help improve access, experience and outcomes for all • Could have a significant positive impact on health inequalities for children and young people and those who experience disadvantage by improved access to more services in the community.
EHIIA Findings • Travel and transport are major issues. Mitigations include: communication; further work with key partners; road network improvements ; and addressing parking issues. • Changes to services can be upsetting and/or confusing. Mitigations include: targeted communication; and service change in relation to accessibility. • Proposals and their feasibility may not be well understood. Mitigations include: strengthening communication regarding the rationale • Ongoing review during implementation.
EHIIA Findings Potential differential Impact • Under-represented Groups – Engage in development and implementation of any future service change • Accident and Emergency Service usage – understand if this would be Urgent or Emergency Care. – Address through ongoing review during any implementation. • Maternity Service usage – The proposed changes enhance existing services.
Joint Health and Overview Scrutiny Committee (JHOSC) Formal response: 19 recommendations grouped into 9 areas Two (9 and 10) for specific consideration: • Explain Urgent Care • Further Clinical Senate review Healthwatch – Submitted to JHOSC
NHS England assurance process To satisfy the NHSE change assurance process, service change proposals are expected to comply with the DH four key tests for service change; • Strong public and patient engagement • Consistency with current and prospective need for patient choice • A clear clinical evidence base • Support for proposals from commissioners
NHS England assurance process (cont) Prior to consultation - three further work areas; 1. Requirement for capital funding will require input from Monitor and DH 2. Need to assess the impact of the Cumberledge review when available 3. Need to continue to engage with the wider health system as the WY U &EC network plans and STP are developed
Four key tests 1. Strong public and patient engagement; • Fulfilled the requirements of the TCI Quality Assurance Process - consistent with their good practice standards. • High level of engagement with the consultation 2. Consistency with current and prospective need for patient choice; • Would provide broadly similar levels of choice in relation to the provider(s) of services. • EHIIA concluded that ‘no indication was found of the proposed changes being discriminatory’ • Mitigating actions identified
Four Key tests (cont…) 3. A clear clinical evidence base: • Model and Standards • Model in line with national guidance & standards • Model and standards assured by YH Clinical Senate. • Commissioners have identified some concerns: • Capacity (beds, community services, Gen Practice) • Planning permission and capacity at CRH • Develop as part of a Full Business Case. • The Kirklees LMC • Concerns consistent with commissioners’ position. • If proceed – work with them to address
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