To consider an update on Healthier Together.
The Board will invite members to provide an update on progress with the consultation on the Healthier Together proposals.
Minutes:
The Chair invited the Board to discuss the Healthier Together programme with the views of the Board being submitted as part of the consultation that was shortly to draw to a close.
The Clinical Commissioning Group (CCG) representatives stated that they would not be voting in relation to this item because they did not feel it appropriate as the CCG was one of the sponsors of the Healthier Together programme.
Tony Stokes (Healthwatch Stockport) submitted a report (copies of which were circulated) providing the Board with an update on Healthwatch Stockport’s involvment with the Healthier Programme and summarising the concerns raised by members during the consultation. The report also posed the Board a series of points that Healthwatch believed the Board needed to be satisfied had been met in preparing its response. The work of Healthwatch Stockport in relation to the transportation implications of the proposals was also highlighted.
The Chair reported that the Stockport NHS Foundation Trust Governors had recently met and had a lengthy discussion about Healthier Together. The Foundation Trust was planning on submitting a joint response on behalf of both the Board and Governors. The issues highlighted by the Governors had reflected the concerns summarised in the Healthwatch Stockport submission.
The Chair stated that the Health & Wellbeing Board were supportive of overall aim of the Healthier Together programme in seeking to minimise avoidable deaths.
The following comments were made/ issues raised:-
· Concerns were expressed about the level of public involvement in the consultation, because of the timing of the consultation and the language used in the documentation. Anecdotally, there appeared to be a high degree of cynicism on the part of the public about the openness of the process and their ability to influence the outcome. Given the scale of the change needed the consultation period appeared to be relatively short. Because so much of the consultation was web based, this may have impacted on the level of engagement. It would have been more engaging for the public to have had the opportunity to participate in a dialogue about the important issues underlying the proposals and for case to be made more explicit about the benefits of reducing the hospitalisation of the health economy, increasing the focus on primary care, and integrated health and social care. The consultation questionnaire could have given the impression that decisions had already been taken as respondents were presented with a stark question about their preferred hospital configuration.
· Insufficient focus has been given to the non-hospital strands of the Programme, namely Primary Care and Integration. The variability in outcomes between hospitals was not unique to that setting, but was also reflected in primary and community care, but there was less data available on mortality rates to evidence the case for change.
· Centralisation of specialised services was not a new process and had been achieved successfully in a range of areas, such as stroke and cardiac care, and through outreach work from other hospitals, such as dermatology, and this should be continued where there was evidence of its efficacy. The labelling of ‘specialist’ and ‘local’ hospitals was therefore unhelpful and confusing.
· In relation to health and social care integration, there was a significant culture shift required but it was important to ensure that user experience was central to developments in this area.
· There was a tension between the public’s desire to have the best possible care even if this meant the need to travel, and the convenience of local services. It was a flaw in the consultation that residents were being asked to give a view about the best strategic direction of the health system when they were not well equipped to do so.
· There remained value in persisting with a general hospital model but to continue with the concentration of specialist services as has already been underway. Efforts to reduce avoidable deaths and improve quality were not solely about hospital configurations.
· There was genuine concern that the proposal would mean that Stockport’s local hospital would no longer provide specialised services.
In response to comments and issues raised, Dr Ranjit Gill (Stockport CCG) highlighted the following issues:-
· Suggestions by those opposed to any changes to hospitals, and echoed by some of those involved at engagement events, that the primary driver for the proposals was financial were not supported by the data made available by the CCGs in Common as part of the business case that provided clear clinical reasons for change.
· There was clear evidence that local diagnostics and treatment through a primary care setting was safer, quicker, more effective and cheaper than the hospitalised alternatives. Pursuing these primary care based alternatives where there was evidence of quality and safety was clinically the right approach.
· The preparation of the Healthier Together Programme and the South-Sector work had provided clear evidence that the local health economy is over-hospitalised, and was also not able to meet the changing needs of the population. The hospital system itself was flawed as it forced Trusts to compete for emergency care, whereas the Healthier Together proposals sought to develop a network of hospitals and to create a single service for patients.
· The evidence for this has been available to commissioners for a number of years but was not acted upon with sufficient urgency, meaning that future change would inevitably be more dramatic, but that it was irresponsible to not act on evidence of avoidable deaths of the scale involved.
· In relation to the consultation, this was designed with an organisation with a proven track record in this area. Due to the complexity of the task in preparing the business cases, the consultation began later than planned but other constraints required it to take place when it had.
The Chair summarised the key themes to have emerged from the discussions as:-
· the significance of the cultural change needed, particularly in relation to the development of single service model of provision;
· there were actions commissioner and providers could and should take in the shorter term prevent people dying unnecessarily, and this should form part of the analysis prior to the next phase of the programme to identify where these can be achieved.
· Greater and more thorough public engagement was needed on the wider implications of the Programme, particularly the Primary Care and Integration strands.
RESOLVED – That the Chair be authorised to prepare a response to the Healthier Together consultation to incorporate the issues raised at this meeting and to circulate a draft to members of the Board prior to submission.