Purpose of the item: For the Select Committee to receive an update from Surrey Heartlands Integrated Care System and Frimley Integrated Care System.
Minutes:
Witnesses:
Mark Nuti – Cabinet Member for Adults and Health
Professor Andy Rhodes – Joint Chief Medical Officer Surrey Heartlands
Louise Stead – CEO Royal Surrey NHS Foundation Trust and Chair of the Surrey & Sussex Cancer Alliance
Helen Coe – Director of Operations & Recovery, Surrey Heartlands
Jo Hunter – Director of Planned Care, Surrey Heartlands
Nicola Beech – Programme Director, Surrey & Sussex Cancer Alliance
Orlagh Flynn – Integrated Care System Programme Director Elective Care, Frimley
Liz Howells – Director of System Planned Care, Frimley
Key points raised during the discussion:
1. The Chairman asked how the current strikes would impact the backlogs. The Joint Chief Medical Officer Surrey Heartlands said that some assessments and surgery scheduled had been postponed because of the strike action. The Chairman asked if cancellations figures as a result of the strikes were available. The Director of System Planned Care, Frimley advised that 2,700 patients had had their appointments cancelled for the four day strike period and patients had been offered new appointments at the time of cancellation.
2. The Chairman asked for further information to be brought back to the Adults and Health Select Committee in a few months’ time to include how long patients had waited for their appointment before they were cancelled and how long the subsequent wait for their new appointment would be in addition to the physical and mental impact of this. Action - Director of System Planned Care, Frimley/ CEO Royal Surrey NHS Foundation Trust and Chair of the Surrey & Sussex Cancer Alliance
3. A Member asked how the imperative to reduce backlogs whilst ensuring that patients receive the most focused and effective care possible was balanced. The Director of Operations & Recovery, Surrey Heartlands said that the focus was to clear patients with the highest clinical priority in addition to considering innovation in treating patients differently such as fit tests and self-care initiatives. The Programme Director, Surrey & Sussex Cancer Alliance said that patient on the cancer pathway was monitored and reviewed frequently to ensure the next action was in place following clinical validation undertaken to conversations with patients and if required, patients being treated more urgently as a result.
4. A Member asked for further information about the aforementioned self-care initiative. The Director of Planned Care, Surrey Heartlands explained that this involved regular contact with patients in addition to providing them with diabetic home tests, blood pressure and ECG monitors with access to digital platforms to upload results. This enabled patients to take responsibility for their own care and provided a way for clinicians to monitor from a distance. The Member asked for further statistics about patients accessing self-care and fit tests. The Director of Planned Care, Surrey Heartlands undertook to investigate methods of reporting these figures back to the Committee. Action - Director of Planned Care, Surrey Heartlands
5. A Member asked how extensive was the use of teledermatology and had the process helped to relieve pressure in skin cancer diagnosis and treatment. The Director of System Planned Care, Frimley said explained as the programme had started in the autumn of 2022, infoarmtion would be provided to the Committee in the longer term. The Integrated Care System Programme Director Elective Care, Frimley confirmed that the programme was available to all GP practices across the ICS and work continued with them to encourage patient use with 2600 people accessing the programme since September 2022 with hospitals experiencing a reduction in patients requiring acute treatment.
6. A Member questioned what measures would be taken to help increase confidence and knowledge amongst males regarding prostate cancer and queried the effectiveness of prostate cancer prevention measures. The Programme Director, Surrey & Sussex Cancer Alliance explained that a five month pilot study in 2022 had invited those at high risk of prostate cancer to meet with a nurse and discuss information prostate cancer, raise awareness and offer Prostate Cancer Screening (PSA) through their GP. The pilot received successful feedback from those that attended and there was a proposal to roll out to other areas. A project for a mobile van to visit busy areas such as shopping centres and car parks to access those unlikely to visit their GP was also proposed for late 2023. The CEO Royal Surrey NHS Foundation Trust and Chair of the Surrey & Sussex Cancer Alliance added that the government was considering the implementation of a national screening programme for prostate cancer for men at higher risk.
7. The Chairman queried if there were enough resources for the Mutual Aid System referenced in paragraph 47, page 166 and asked how many people were benefiting from it. The Director of Planned Care, Surrey Heartlands said that resources were dependent on specific situations.
Rebecca Jennings-Evans left the meeting at 12. 53.
8. A Member asked how figures were impacted by patients residing outside of Surrey choosing to be on waiting lists within the county. The Director of Planned Care, Surrey Heartlands confirmed that there were two waiting lists, one to reflect the numbers of those resident in Surrey and one to reflect the size of those trying to access care in Surrey.
9. A Member asked to what extent were patient records sufficiently accurate and synergised for the purposes of cancer and elective care. The Joint Chief Medical Officer Surrey Heartlands explained that whilst the implementation of both platforms had been challenging, particularly on the administrative side, there were huge clinical advantages in bringing all records together adding that a recent external audit process would bring about the resolution of any data problems to drive the benefits forward.
10. A Member asked Frimley to expand on some of the benefits and advantages of utilising the EPIC system referenced in paragraphs 34 to 37, pages 164 to 165. The Chairman asked what was the cause of any challenges with EPIC. The Director of System Planned Care, Frimley noted that here were initial issues with the recording of data such as duplication which had resulted in it not being ready for publication.
11. The Chairman, in referring to the Harm reviews noted in both reports, asked for a definition of Harm. The CEO Royal Surrey NHS Foundation Trust and Chair of the Surrey & Sussex Cancer Alliance said that the Harm reviews were a clinical review and addressed any deterioration in a patient’s condition.
12. The Local Healthwatch Contract Manager, Healthwatch Surrey asked what reassurance were there that patients and carers were communicated with regularly and given the updates about when to expect their treatment and given advice. The Director of Planned Care, Surrey Heartlands noted that the Frimley patient portal would enable more effective, timely and efficient communication to those on waiting lists. The ‘My Planned Care’ website was also available, however the information provided was high level and would not break down clinical priority. A National Health Service England (NHSE) programme called ‘Waiting Well’ encouraged better engagement across primary and secondary care to help patients wait well and avoid deterioration by maintaining a healthy lifestyle whilst waiting for surgery.
13. A Member questioned to what extent was patient choice a factor in prolonged waiting times. The CEO Royal Surrey NHS Foundation Trust and Chair of the Surrey & Sussex Cancer Alliance explained there were many reasons for patients choosing to cancel appointments or planned surgery such as school holidays and patients could choose to postpone up to three times before a conversation took place with them to provide information on which to base their decision.
14. The Chairman, in referring to item 19 on page 173 of the Surrey Heartlands report which noted that ethnic minority groups were less likely to access services and were therefore not visible to analysis asked for further information about this as requested previously by the Select Committee. Action – Director of Planned Care, Surrey Heartlands
15. A Member asked what work was involved in the Surrey Heartlands and Surrey Minority Ethnic Forum (SMEF) development of the digital exclusion strategy referenced in paragraph 20, page 173 and queried how this would help to address the issues of lack of access and the digital skills required to enable ethnic minorities to attend virtual consultations. The Director of Planned Care, Surrey Heartlands said that whilst most of the work was being undertaken in the community by primary care colleagues, tech angels were working as support outreach workers to identify those that found it more difficult to access services. SMEF had identified populations that clinical colleagues could have conversations with and signpost to tech sessions. The Director of System Planned Care, Frimley noted the specific work to target the homeless population utilising some of the learning from the COVID pandemic to achieve this.
16. A Member questioned what steps would be taken to increase prevention and awareness of cervical cancer amongst Black, Asian and Minority Ethnic (BAME) Women, particularly given the potential taboos surrounding sexual health within elements of these communities. The Director of Planned Care, Surrey Heartlands said that specific engagement had taken place with BAME communities regarding cervical screening and work underway with the pathology network to develop self-test kits for women to use in the privacy of their own home in addition to pilot clinics for anxious women from any background.
17. A Member asked how the quality of packages upon discharge was monitored and coordinated and queried to what extent families and carers were involved in or received guidance on how to provide effective aftercare. The Director of Operations & Recovery, Surrey Heartlands explained that many of the discharge care decisions were made at the preoperative assessment to inform and support the process upon discharge with families and carers involvement. The Chairman noted a previous recommendation made by the Committee around the thorough provision of discharge notes and information being readily available for families and carers, however this was still not routinely available and suggested a survey was conducted to ensure satisfaction.
18. A Member asked what mechanisms were in place to ensure the recording and measurement of patient feedback bearing in mind those that were digitally excluded. The CEO Royal Surrey NHS Foundation Trust and Chair of the Surrey & Sussex Cancer Alliance said that complaints and information from the Patient Advice and Liaison Services (PALS) were used alongside conversations with Healthwatch Surrey and friends and family gradings. Other efforts include a patient story heard by the board every two months and a patient panel and a review of social media at the Royal Surrey Hospital to include the voice of residents.
Recommendations
Actions/ requests for further information: