Dulwich Programme Board Minutes of the meeting held on 4 July Tooley Street

Transcription

1 Dulwich Programme Board Minutes of the meeting held on 4 July Tooley Street Present: In attendance: Apologies: Andrew Bland Chief Officer, SCCG AB Tamsin Hooton Director, Service Redesign TH Rebecca Scott Programme Director- Dulwich- SCCG Colin Beesting Communications & Engagement Manager- SCCG CB Rosemary Watts Head of Membership and Engagement- SCCG RW Sian Howell Clinical Lead- SCCG SH Olufemi Osonuga Clinical Lead- SCCG OO Alvin Kinch Healthwatch AK Julian Alexander NHS Property Services JA Patrick Roberts NHS England PR Harjinder Bahra Equality & Diversity Manager- Southwark CCG HB Alex Laidler Adult Social Services- Southwark Council AL John King EPEC Patient Representative JK Shirley Lawrence GSTT Community Services SL Janet W-Atkinson Minute-taker JW Michael Thompson Opinion Leader MT Nicola Blythe Opinion Leader NB Gemma Novis Verve GN Robert Park Chair Lay Member, SCCG RP Roger Durston (represented by Sian Howell) RD Malcolm Hines Chief Financial Officer, SCCG MH Jill Solly Head of Primary/Secondary Interface, King s JS Leighann Li (represented by Shirley Lawrence) Head of Customer Services & Facilities Management GSST Comm Services LL 1. Introductions and Apologies AB welcomed everyone to the meeting, and introductions were made. Action 2. Conflicts of Interest The Chair asked whether there were any changes to Conflict of Interest and none was declared. Members were asked to sign the Conflict of Interest schedule recording this. 1

2 3. Previous minutes and matters arising Minutes of 23 May The minutes of 23 May were agreed subject to two minor amendments to ensure clarity. Matters Arising confirmed that she is still in discussions with GK s team about mental health services. confirmed that she had pursued the organisational responses and that we had received responses from all key local partner organisations. Post consultation process and timetable confirmed that she had made changes requested and included the South Southwark Locality Commissioning Group and the South Southwark locality PPG in the schedule of meetings. Communication/engagement plan this work is on-going The Alternative Proposal is being considered by a panel as agreed, including a mix of people new to the project and those who have been involved throughout. There has been strong input from the clinical leads and patient reps/healthwatch. Minutes of 25 April The amended minutes of 25 April were noted. /RW 4. Community engagement This item was for noting. The summary minutes from today s meeting will be incorporated with the Chief officer s report to the Governing Body on the 11 th as usual. 5. Draft Consultation introduced the item, and noted that there had been some changes since the document was circulated. She commented that these were mainly minor corrections, but that there was one new section. She circulated a sheet detailing the additional section- 3.8 Stakeholder meetings which drew out some key messages from stakeholder groups including people from the community covered under the Equalities Act. Nicola Blythe (NB), from Opinion Leader, presented the findings from the consultation as set out in the draft consultation report. NB talked to slide pack Improving Health Services in Dulwich and the Surrounding Areas and outlined the structure of the consultation, key themes and the conclusions. This was followed by discussion and questions. NB noted that they had collated information from 215 surveys responses and letters and 74 stakeholder events and deliberative events which together had 568 participants. A further 600+ people had been briefed at other events about the consultation and the proposals, and had had an opportunity to ask questions. The conclusions from the report summarize the key points, and are: There was strong support for the CCG's overall direction, with important caveats about cost and accessibility. There was particular support for 2

3 delivering preventive care in the community but some individuals had concerns about the location of these services Option A is preferred to Option B overall, the variable standard of GP services being the driving factor. Other benefits individuals mentioned with regard to Option A was the concentration of expertise, the potential for care to be joined up for key groups like pregnant women, the elderly, and mental health service users, and for coordination with other health and social care providers GP services are well regarded overall; however, the standard is variable. There is some sensitivity about the capacity of GPs to take on additional services, but some individuals are keen to ensure they do not have to travel further or see multiple healthcare professionals to receive health services out of their GP practice. Concerns about potential fragmentation of care and decrease in quality and accessibility due to the new approach to healthcare delivery need to be allayed. This point was raised irrespective of the Option that NHS Southwark CCG might go on to pursue. Discussion and action points were: Support for the direction overall for proposal is high, and Option A has a higher level of approval than Option B. However, some people clearly liked or disliked both models. There are concerns from people about GP access if GPs are taking on more roles. There was a slide which included a point saying that some people wanted no change. Clarification was sought on this, as this is not a message that comes across in the document. It was noted that the slide gave the range of responses, rather than the most frequent ones, and it was agreed that this should be clarified for future presentations. Some people were concerned that the additional services currently available from their GPs might not be available in the future. AB asked whether it was people with a positive view of general practice who had expressed this concern. NB said she would review the data. The same slide noted that there is Some sensitivity over GP Practices even through variability on quality, and there was a discussion about this. NB said that the key message is that people really valued good general practice, and this came across consistently from respondents. However, people were aware that experiences were varied. AB asked for clarification that the information in the presentation pack was what all respondents thought, rather than just the survey respondents. NB confirmed that the information was drawn from a range of respondents both surveys and qualitative information from the discussions. She noted that although only information from the survey could be represented in the graphs and diagrams, the text gave a full description including the qualitative data. The fact that people recognise and support the case for change. It was noted that we need to build on this to ensure that services change for the 3

4 better. Implicit in the consultation is that we are trying to both improve services and make them more cost-effective. A question was asked about the breakdown of the respondents and participants, and it was noted that for the survey the age breakdown was evenly spread across most age groups, and that the ethnic breakdown was broadly representative of the local population. However it was noted that some of the stakeholder events were targeted at groups in the community which had been highlighted by the Equalities Impact Assessment as important to hear from. There was a request to have a slide added the presentation to cover age and diversity. NB confirmed in answer to a question that there was no significant difference between the views of the people from with groups with characteristics protected under the Equalities Act and those of the whole population. There were however a number of specific comments made by people in the course of the discussions that might give useful insights into their experiences of using the services. Transport/mobility In the discussions, when you asked people with disabilities about the location of services they were less concerned, because they mainly travelled by car/patient transport. However, people without physical disabilities were concerned about transport links. It was noted that the stakeholder organisations responding (including KHP, GSTT, KCH, SLAM, both neighbouring CCGs, the LMC and LPC, Southwark Council and others) mainly expressed a preference to Option A. There was a question about GP input into the consultation, and SH confirmed that updates and opportunities for discussion had been given at several South Southwark Locality Commissioning Meetings. confirmed that GPs attended many of the practice PPG meetings where it had been discussed. NB noted that this meant that feedback from GPs was mainly qualitative and therefore on the whole not represented in the graphs. There was a question about the number of complaints we had received about the process, and it was confirmed that there had been three. It was noted that need to be able to respond to any questions about complaints at the Governing Body meeting. Opinion Leader were asked to include any white mail responses not included in the wider analysis as an appendix to the consultation report. It was noted that this would essentially include the ERW response and the letters from stakeholder organisations. Opinion Leader were asked to draw out any key points (eg option preferences) from formal responses from stakeholder organisations in future presentations Opinion Leader were asked to use updated CCG branding 6. Equalities Impact Assessment version 2.1 Gemma Novis commented that the Southwark CCG consultation process was one of the best that Verve has been involved in. This is particularly because they have been involved in the consultation design and process as well as being able to offer proposed recommendations for the implementation of any proposals. They are confident that the process would stand up to scrutiny. 4

5 GN talked to the document Enc 6 Improving health services in Dulwich and surrounding areas: Initial Equalities Impact Assessment. She noted that this document had been reviewed twice before by the DPB as it had evolved with the process. This iteration had incorporated an additional section which showed how the wider recommendations for consideration by the CCG were being addressed at present. The following feedback was to the group: Results of the Initial Equalities Impact Assessment (Page 9) - some of the ambers will move to green following the consultation process, and some will remain representing the continued need to engage with some specific groups. From an equalities point view both Option A and Option B are viable options The EQIA will need to be reviewed when the SCCG is making its decisions, and then followed up next year to ensure that the recommendations have been addressed. GN asked the group whether there was any further information required. CB noted, that of the characteristic groups it had been most difficult to reach gender reassignment and therefore it might be useful to think how this group could be included in any future work. noted that in the report under gender 1% saw their gender as neither male or female, however, it was agreed that it couldn t be assumed that these were people from the gender reassignment group. GN said that she would be updating the EqIA in the light of the report, and that she would get the updated version to for distribution to the Governing Board. GN/ 7. Alternative Proposal The Rylance-Watson response reported that the CCG had received a single Alternative Proposal, and that it was being assessed by a panel as agreed at the last DPB meeting. The response to the Alternative Proposal would be shared with ERW. said she had confirmed with ERW that her proposal could go into the public domain, and it was noted that ERW had been distributing copies at the HealthWatch launch meeting. The Programme Board noted the on-going work on the assessment, which will come back in draft to the next meeting of the DPB for full discussion and finalisation. said that she was also making available copies of the full proposal so that members could see in full both the vision/thinking as well as the detail of the proposals. The panel had met the previous week and had taken the view that there needed to be both a response to the issues/vision as well as the detail of the services she was proposing. noted that the final version will probably be in a slightly different presentational form. 8. Comment on very early draft of recommendations to the Governing body reported that a sub-group which included two Clinical Leads worked on the document. This was an early draft, based on the first draft of the consultation report. They will be further refined when the final report and the work on the Alternative Proposal is completed. The next step will be for them to go to the 5

6 Commissioning Strategy Group to discuss the scope and the level of detail in order to get a sense of the level of detail and identify any particular issues as a result of the consultation. Comments/questions on the early draft were: This early draft is fairly bland and non-confrontational- do we want these recommendations to be more focussed? People strongly approve of community-based care and they want it developed around them with links with General Practice and the Acute sector. We should seek confirmation from the Commissioning Strategy Group on committing to Option A, and then get discussion going among the clinical leaders about how hard to push the clinical model changes. Once a choice has been made then the alternative options need to be set aside. People responding to the consultation did not talk much about the buildingthis was a genuine debate about services and the clinical model. We need to be able to assure people that the Option A facility will accommodate the services required, and allow room for manoeuvre. This links into the Primary and Community Care Strategy work. SH said that given the pressures that general practice are under at the moment, we need to think how to ensure that the strong and positive message about valuing good general practice can be conveyed to GPs. It is clear that there is not currently an equal GP service across the area. We must address this with GPs. AB summarised that there are three key points: The narrative for this is a vote of confidence for the clinical model, and is a mandate for the type of community service we would like to see With some caveats it is also a mandate for progressing Option A. Between now and September we can articulate our draft primary and community care strategy through this model. As a result AB said that we can now give a number of clear and consistent messages that come from the consultation and our subsequent decisions, the TSA work, and the Primary and Community Strategy. TH asked that we clarify the point about accessing urgent care at weekends There was also a discussion about GP premises beyond any development on the Dulwich Hospital site. On the premises is there something about need to recognise some premises will not be able to provide the level of service needed, and therefore they need to consider how they will be able to do so in the future. AB said that as the issues of funding GP premises developments are wider than just Southwark and so there needs to be a wider discussion. He reported that he had proposed to David Sturgeon and Robert Braham that there be a discussion about south east London more generally, using Dulwich as a case study, to see how we can make this happen in the new 6

7 world. JA raised the different financial models, and the probable impact of the cost of new premises for GP practices. said she had had discussions with Jill Webb (NHS England) about the financial implication for practices considering moving to a new centre on the Dulwich Hospital site. She noted that we have agreed with the LMC that practices will be visited and conversations had on where they see their future. noted that in the pre-consultation business case there were assumptions about the cost implications of two practices moving in, but not others. JA also highlighted that finances now sit indifferent places. 9. Workplan period 1 June 12 September for noting talked to the time line, which has changed since the papers were distributed. Highlights are: Consultation report and EqIA to go to the Governing Body on the 11 July. Public meeting giving feedback on the consultation - 8 August, venue to be confirmed. Opinion Leader will present their findings. Recommendations to be presented to the Governing Body in September 10. Governance Risk log This was not available at the meeting due to IT problems. This will be available at the next meeting in three weeks. 11. Any other business TH noted that her team was working with to review all community based services. This process would bring together the outcomes of the primary care strategy work and the consultation. 12. Next meeting It was agreed that the August meeting be moved to the 29 August to avoid as much of the holiday period as possible, and also to allow ample time for the distribution of papers to the Governing Body meeting on the 12 September. /CB/ RW/ /TH 7