Agenda item

Purpose of the report: To provide a summary of the process undertaken to commission an Integrated Sexual Health Service for Surrey

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:

1. 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.
   
   
2. 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.
   
   
3. 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.
   
   
4. 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.
   
   
5. 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.
   
   
6. 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.
   
   
7. 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.
   
   
8. 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.
   
   
9. 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.
   
   
10. 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 1^st 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.
    
    
11. 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.
    
    
12. 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.
    
    
13. 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.
    
    
14. 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.
    
    
15. 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.
    
    
16. 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.
    
    
17. 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.
    
    
18. 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.
    
    
19. 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.
    
    
20. 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.
    
    
21. 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.
    
    
22. The provider noted that Sexual Health and HIV services would be delivered within requirements set by Surrey County Council and NHS England.
    
    
23. 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.
    
    
24. 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:

1. That the performance of the sexual health and HIV service contracts are reviewed in 9 months’ time.
   
   
2. 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.