Agenda item

To consider a report of the Stockport Clinical Commissioning Group.

The report seeks to describe the current status of the Improving Specialist Care programme, formerly known as Theme 3 – Standardising Acute and Specialised Care Programme. The content of this briefing is based on the verbal updates provided to Greater Manchester Joint Health Scrutiny Committee on 14 March 2019.

The Scrutiny Committee is invited to comment on the report.

Officer contact: Noreen Dowd, 0161 426 9903

Gillian Miller, Associate Director of Commissioning, Stockport Clinical Commissioning Group, attended the meeting to present a report (copies of which had been circulated) updating the Scrutiny Committee on the Greater Manchester Improving Specialist Care Programme, formerly known as Theme 3 – Standardising Acute and Specialised Care Programme. The clinically led Programme sought to address variation in care across different hospitals, as well as pressures on staff and resources.

The Programme had eight specialist services within scope:-

·         Benign Urology services

·         Cardiology services

·         Respiratory services

·         Musculoskeletal/Orthopaedics services

·         Paediatric Surgery services

·         Breast services

·         Vascular services

·         Neuro-Rehabilitation services

Each service would be subject to differing models of care depending on service and patient need, and these would be subject to clinical agreement and engagement.

The following comments were made/ issues raised:-

·         The proposals were similar to previous exercises in relation to stroke services that had resulted in the creation of a series of specialist, high quality sites. That had been successful.

·         Concern was expressed about patients having to travel across Greater Manchester to access services previously available at their local hospital and the inevitable increase in journeys and emissions, and that without appropriate transport infrastructure in place there was a danger that vulnerable residents would miss appointments, increasing waste and reducing outcomes. In response it was stated that the models had been designed to provide as even a distribution as possible of access to a service that would provide both surgical and screening services. The consequence was likely to be that for some of the services in scope would not be available at all sites, but for others may be delivered on a ‘hub and spoke’ model. For other services change would not necessarily impact delivery but instead be an increased emphasis on standardisation and following best practice guidance. Modelling was currently being undertaken by TfGM on travel patterns for patients and users of these services, including the pattern of users of services accessing via blue light transport.

·         Further comment was made that previous modelling on patient transport had suggested that relatives were travelling from as far away as Nottingham to ensure that relatives were able to attend appointments that were relatively short distances from their home. It was therefore important that appropriate appointment procedures were in place and central to the modelling process.

·         Clarification was sought on the governance arrangements for the Programme and on timescales for delivery. In response it was stated that the Joint Commissioning Board (made up of NHS and Local Authority representatives) would take the decision on future models of care, but that discussions were ongoing about future commissioning arrangements. It was anticipated that there would further engagement over the detailed models of care over the autumn with a decision taken by the end of the year.

·         The importance of communication between providers was identified as a key concern, particularly in light of proposals to have ‘hub and spoke’ models of delivery. This point was acknowledged and assurance given that there were ongoing work streams in relation to ICT. Once decisions had been taken on sites etc., further detailed work would be undertaken on communications infrastructure. The stroke service was cited as an example of where communications had been successfully integrated.

·         Comment was sought on whether GPs would have sufficient capacity for the potential extra work for localised follow-up from specialised services. In response it was stated that it remained the expectation for some of the services in scope to have localised follow-up services delivered through the ‘hub and spoke’ and in other cases decentralised services would remain in local hospitals. There was separate but complementary work being undertaken on transforming primary care to create greater capacity to meet public need.

·         Clarification was sought on the difference between this Programme and that of Healthier Together. In response it was stated that Healthier Together was a separate, but related piece of work focussing on particular areas of acute care. This Programme focussed on different specialist areas of care, but would draw on the lessons of the earlier programme and would be aligned to it. It was further commented that the case for specialisation had been won and that there was now an inevitability to the centralising of such services, but that it was important to ensure this worked most effectively in the circumstances of Greater Manchester.

·         It was suggested that councillors would welcome the opportunity to engage further in the consultation and development process for the Programme.

RESOLVED – (1) That the report be noted and that Gillian Miller be thanked for her attendance and presentation.

(2) That the Deputy Chief Executive be requested to circulate details of the detailed models underpinning the Improving Specialist Care Programme.