Witnesses:
Members
Helyn Clack, Cabinet Member for Health
Speakers
Matthew Parris, Deputy Chief Executive Healthwatch
Stephen Fash, Resident and
representative of the Blanche Heriot Group
Cliff Bush, Co-Chair - Surrey Coalition of Disabled
People
Commissioners
Helen Atkinson, Strategic
Director for Adult Social Care and Public Health
Ruth Hutchinson, Deputy
Director - Public Health
Lisa Andrews, Senior Public
Health Lead
Steve Emerton, Delivery Director South East, NHS England
Fiona Mackison, Service Specialist, Specialised
Commissioning, NHS England
Providers
Stephen Tucker, Deputy Service
Director, Central and North West London NHS Foundation
Trust
Simon Edwards, Clinical
Director, Sexual Health and HIV Services, Central and North West
London NHS Foundation Trust
Ashford and St Peter’s
Hospital
Tom Smerdon, Director of
Operations, Ashford and St Peter's Hospitals NHS Foundation
Trust
Declarations of Interest:
David Mansfield informed the
Committee that he worked for Central and North West London NHS
Foundation Trust in a non-clinical role. He withdrew from the
room.
Key points
raised during the discussion:
-
The Committee heard representation from the Deputy
Director of Healthwatch, Surrey. It was noted that representatives
of Healthwatch had attended several feedback events regarding the
change in service offered by Central and North West London (CNWL)
NHS Foundation Trust. They expressed the opinion that there was a
lack of explanation of the services being offered by the new
provider. Healthwatch also felt that there was inadequate
consultation work with regard to the changes undertaken by the
commissioners and providers. Healthwatch noted that, since the
referral has been made, there has been more evidence of
consultation made available. Healthwatch questioned whether the
communication and consultation undertaken was wide enough and
whether patients with chronic disabilities would still be able to
adequately access services.
-
The Committee heard representation from a member of
the Blanche Heriot Unit Group (BHUG). He expressed the opinion that
patient support needs were significant for the services. He
stressed that the Blanche Heriot Unit (BHU) serviced a large
population in North West Surrey and that there was a higher than
average demand for the services. It was also noted that the unit
was used as a training resource for staff working with sexual
health issues. The representative of the BHUG suggested that BHU
patients were not sufficiently involved in consultation during the
re-commissioning of services. He noted that the commissioners
decision to reduce the overall spend of the provision for sexual
health services was a primary reason for the former provider being
unwilling to bid to provide the service and that this limited
competition. There were also concerns raised regarding CNWL‘s
ability to provide the service, noting that the provider was
running at a budget deficit and that they could become
overstretched and unable to provide services effectively in
Surrey.
-
Representatives questioned the quality of
CNWL’s current offer of Sexual Health Services, noting that
there were some concerns regarding the emphasis on phone and email
contact, rather than face to face services currently offered. The
phone services were also deemed by “Mystery Shoppers”
commissioned by the BHUG to be slow and unresponsive. Concerns were
also raised regarding how the new service was proposed to be
delivered, noting that the BHU was significantly larger than the
Level 3 Genito-Urinary Medicine (GUM),
HIV and Contraception services proposed in Buryfields, Guildford, and that this could cause
capacity issues. The BHUG proposed that the service extend the
contract for a further six months to the previous provider, in
addition to the current six months that have been added, to allow
for a more effective transfer of services.
-
The Co-Chair of the Surrey Coalition of Disabled
People noted that he considered the levels of consultation to be
inadequate, highlighting that the Surrey Coalition of Disabled
People were not aware of the consultation regarding the
recommissioning for a significant period of time. It was also
suggested that the Surrey Coalition of Disabled People were not
provided with an impact assessment by Surrey County Council
regarding the impact on patients. The Co-Chair commented that the
commissioner had not undertaken sufficient consultation with those
with hearing or visual impairments, young people, or those with
mental health issues. It was also noted that the Buryfields, Guildford and Earnsdale, Redhill proposed sites were difficult to
access for those with disabilities and chronic needs.
-
The Cabinet Member for Health explained to the
Committee that Surrey County Council faced significant financial
pressures, highlighting the need to make cost reductions of
£104 million in the financial year 2017/18 as determined in
the Medium Term Financial Plan. It was also noted that government
grants had been lower than expected, and that the the ring-fenced Public Health funding was coming to
an end. The Cabinet Member recognised the need for cost reductions,
the quality of service would be closely monitored by Surrey County
Council (Public Health) and NHS England.
-
The Cabinet Member for Health noted that the
recommissioning of sexual health services was a positive
development and that the service welcomed the saving options that
it provided. The Cabinet Member stressed that the new model of a
“hub and spoke” method of delivery was cost effective
and could effectively deliver the services required across the
entire county; stressing that the re-commissioning of services
should be taken in the county context, rather than only considering
the BHU.
-
Officers noted that the recommissioning of sexual
health services and the budget in Public Health had been brought to
the Committee’s predecessor for scrutiny.
-
Officers highlighted that they had observed national
guidance, other service’s methods of delivering treatment for
sexual health issues and implemented instances of best
practice.
-
The service noted that they were conducting
follow-up engagement with service users, and that the Equalities
and Impact Assessment for the changes was part of the Cabinet
papers in September 2016, and available to the public on the Surrey
County Council web site.
-
Officers noted that the current service provision at
ASPH (Ashford St Peters Hospital NHS Trust) were being retained for
a period of six months until October 1st 2017 in order
that current service users are adequately provided for,
particularly being mindful of those with chronic conditions, and
ensure that the service is able to cater for patients during the
transition.
-
It was stressed by officers that any additional
extension of the contract to the current provider for a further six
months, to the six months currently in place, would result in the
service making double payments to two providers. This was
highlighted by officers as being an unnecessary use of public
funding, stressing that both the commissioners and providers
considered that they were prepared for the safe transfer of
services.
-
The new model of service delivery, particularly in
the case of its HIV services, was in line with the King’s
Fund guidance. However, the new provider noted that there was a
need for better co-ordination of care.
-
The new provider explained to the Committee that the
main site for service delivery would be in Guildford, but that
there would also be support available via email and telephone. It
was also noted that, in cases of chronic illness, that medication
could be delivered to patient’s homes in the case that they
were unable to reach their area of service delivery.
-
The new provider would be offering online booking in
conjunction with use of a mobile app and the telephone to book
appointments for sexual health services, which was targeted at
young people who require these services. Members stressed that
young people must be considered during the recommissioning of
services, highlighting the requirement for accessibility for young
people.
-
Officers explained that there had been, as part of
the recommissioning process, a sexual needs assessment which
included focus groups undertaken to consult with patients on the
changes to the recommissioned services. It was also noted that
paper and online surveys had been distributed to services users to
gather their feedback, including an anonymous survey. There was an
opportunity highlighted to provide feedback at a workshop event in
early 2016. It was stressed that there would be continued
discussion and engagement with patients and staff regarding how to
manage the changes with providers and patients.
-
The representative from NHS England explained that
they had worked closely with Surrey County Council. It was noted
that national service specifications were used for the NHS England
element of the recommissioning of sexual health services.
-
Members questioned how many service user responses
had been received when gathering feedback. It was noted by officers
that there had been 300 responses to the initial survey and that
there were a number of meeting sessions which were well attended.
Members noted with concern that the total number of service users
across Surrey was significantly higher and that consultation should
reach a wider audience.
-
The Committee queried what the focus and purpose of
further consultation with patient groups would be in future.
Officers noted that the process would ensure that patient groups
were involved in the forward planning process and mobilisation
process.
-
Officers noted that the CNWL NHS Trust was one of
the largest providers of sexual health services in England and that
they had recently received a result of Outstanding in the 19 June
2015 Care Quality Commission (CQC) inspection of sexual health
services.
-
Members requested that the new providers improve
dialogue with service users in response to the concern that there
was a low level of consultation. Officers and providers stressed
that this improved dialogue with patients was in place and that the
provider had evidenced changes to their proposed offer in response
to user feedback.
-
Officers noted that the performance of the provider
would be monitored by Surrey County Council and NHS England. It was
also noted that Public Health in Surrey was monitoring outcomes of
a performance comparison with comparable local authorities. The
provider responded to concerns raised by Members and stressed that
they would provide the Committee with the provider’s
performance compared to national performance indicators.
-
The provider noted that Sexual Health and HIV
services would be delivered within requirements set by Surrey
County Council and NHS England.
-
The Committee noted that it would like explore the
consultation undertaken by the service with regard to the
recommissioning of sexual health services and determine whether
there was scope for improvement in future.
-
The Committee suggested that the mobilisation of
services should be monitored, with a follow up report suggested to
be presented to the Committee in spring 2018.
Recommendations:
The Committee notes the concerns of patients, and
thanks people for their evidence. It recommends:
- That the
performance of the sexual health and HIV service contracts are
reviewed in 9 months’ time.
-
That the Committee establish a task group to review
the implementation phase, consultation process and lessons to be
learned from the commissioning of sexual health and HIV services,
with a view to informing future commissioning of
services.