Agenda and minutes

The Chairman declared an interest in item 4 ‘Single Strategic Commissioning Organisation’ as he had previously Chaired a Clinical Commissioning Group board.

Report of the Clinical Commissioning Groups

Sally Young, Director of Corporate Governance, Communications and Engagement and Anna Collins, Associate Director of Communication & Engagement attended the meeting to present the report and answer questions.

The Committee were being asked by the Staffordshire Clinical Commissioning Groups (CCG’s) to provide feedback on the proposal to become a single Strategic Commissioning Group.  All stakeholder consultation feedback would be reported to the CCGs GP membership during their consideration.  The GP recommendation would then be conveyed to the CCG’s governing body.  Any application to merge would then have to be made to NHS England with a view for it to commence in April 2020.

The consultation had started in May and would conclude in July 2019.  A number of public meetings had been held and the CCG website had links to the documents.

15 other groupings of CCG’s in the Country were also going through this process at the same time.

The potential benefits of merging were outlined as:

To the public

•      Local delivery, through Divisions, working to keep patients at the centre of all they do.

•      Help reduce variations in patient outcomes and improve patient experiences.

•      Stronger patient engagement (e.g. focussing on services and improving outcomes).

•      Reduced duplication - doing things once, not multiple times (as envisaged by the Long Term Plan).

•      Help deliver care closer to home by strengthening community services.

•      Strengthen providers and commissioners working together.

 To GPs

•      Stronger primary care voice with providers within the Divisions.

•      Enable GPs to do things once.

•      Free up time for staff to deliver once rather six times.

•      Clarity in decision making processes.

•      A focus on Divisions deciding how they will implement a single strategy.

•      Support GPs working together.

To Commissioners

•      Focus on outcomes by strengthening our Divisions and giving delegated responsibility for local decision making to Divisional Committees.

•      Quicker and simpler decision making.

•      Better relationships with providers.

•      Higher quality strategy.

•      More efficiencies which can reduce costs and our deficit.

To Providers

•      Better relationships and integrated working.

•      Quicker and simpler decision making.

•      More control over the design of services and also about working together as a system.

An overall advantage was that one single CCG would to align with the Sustainability and Transformation Partnership (STP).

Currently the options available were:

1.    Keep the current arrangements of six separate CCGs under a single leadership team

2.    Develop a new, single CCG

If NHS England were not in favour of option 2, the CCGs could relook at alternatives next year.

With regard to the recent NHS England’s CCG assessments, Members asked if five of the six CCG’s rated as “inadequate” would reduce the number of “inadequate” CCGs to one and was this a national motivator to encourage mergers.  The Committee was informed that there were 5 different domains covered in the assessment process. However, if the financial domain is viewed as inadequate the overall rating would always reflect this, regardless of the findings in the  ...  view the full minutes text for item 15.

Report of the Clinical Commissioning Groups

Lisa Agell, Head of Mental Health Services, Midlands Partnership NHS Foundation Trust and Nicola Harkness, Managing Director, South East Staffordshire CCG’s, attended the meeting to present a report in relation to the engagement plans for the George Bryan Centre. 

A fire at the Centre earlier in the year had led to the transfer of patients to St Georges Hospital, Stafford.  It had since been decided to close the East Wing and the West Wing closed temporarily pending consultation about the future service provision for South Staffordshire.

The Committee was informed that the facility was a short stay service with an average stay was 21 days.  The current capacity at St Georges was 12 short stay beds.  Following the fire, patients were moved to St Georges, but no patient was discharged early or without a discharge plan. 

The consultation process was described. 

Security to the building was being provided until discussions with local partners were held to decide if there was a temporary use for the buildings.  There were proposals to house the Community Mental Health services which is currently located in the Sir Robert Peel building.  There were also discussions taking place over the Milford Ward which is normally used to support hospital winter pressures and the affect this would have on reducing capacity.

Members expressed concern that patients and families had to make a 60 mile round trip from Tamworth to Stafford and this was not acceptable, they felt that the need was in Tamworth and patients needed to be treated in their own communities.

A question was asked on the current location of the “Place of Safety” This was a facility where people who are at risk to themselves are placed but for a temporary measure until assessed.  The facility can only be assessed by the Police.  In the South of the County there were three assessment rooms and one in the North.  There was no national guidance on the amount of facilities needed, it depended on local demand. 

Following a question on the capacity of the ward prior to the fire, the Committee was informed that the George Bryan Centre was never 100% full.

RESOLVED:

a)    That the CCGs and Midlands Partnership Group be informed that the Committee felt that the 12 bed based facility, should remain in Tamworth.

b)      That following the consultation, the CCG should bring detailed proposals to the Committee for consideration.

Report of the Clinical Commissioning Groups

Nicola Harkness, Managing Director South East Staffordshire CCG’s, attended the Committee to explain the commencement of the procurement process to secure a provider to deliver community services, following the termination of the Improving Lives contract by Virgin Healthcare Services Limited in April 2019.

Following a question on funding for the contract, it was explained that the CCG had carried out a benchmarking exercise with other CCGs and there was confidence that there was sufficient funding to commission community services.

A Member felt that this was a window of opportunity to address some of the cross boundary issues in South Staffordshire, with different systems between primary and community care.  Members questioned how the whole community hospital relationship process would be made more seamless.  It was explained that the procurement process was underway and the potential bidders would be known in November 2019. One of the key areas of inquiry as part of the bidding process would to understand how each bidder would aim to better integrate services as this was a key part of the NHS Long Term Plan.

The Committee were informed that the reasons for the termination of the contract had been explored and any learning from this information would be used to inform the development of the procurement process.

RESOLVED: That the report be received.

Report of the Clinical Commissioning Groups

Redecca Scullion, Deputy Director of Commissioning and Operations for Staffordshire and Stoke on Trent CCG’s and Ashley Shatford, Urgent Care Strategic and Operations lead for the six CCG’s attended the meeting to present the report and answer questions.

The Committee was informed of the plans to deliver the new national service specification for Integrated Urgent Care which included the integration of GP Out of Hours and NHS111 services.  The service would be more aligned to a single point of access.  The procurement process and timetable were explained.  The new service would be operational from 1 October 2020.

It was explained that the current service was made up of a number of services which were difficult to navigate for patients.  This confusion and lack of access to urgent care appointments often lead to an over reliance on A&E services.  During the development of the specification, small pilots had been in operation in order to test the impact on patients and services.

A Member expressed concern that if the procurement was due to the mandate of a national specification and also a realignment with the STP model, would it fully integrate with all partners such as the West Midlands Ambulance Service (WMAS) and Mental Health Services, as full integration of both services and information was needed.  It was also asked if there had been any analysis of the failures of the current services to access and if patients were in the wrong service and which partner had referred them.  It was felt that this would highlight the problem areas, which could be addressed without the need for re-procurement.

It was explained that services such as WMAS and Mental Health were part of the Integrated Urgent Care and overall delivery and as part of the procurement process they would be consulted to see how they could support the integration of the 111 service in order to provide a system integration.

The current system was operated on a binary process and any future service needed to see a more clinical judgement.  This should be possible through access to patient information records which could lead to better alternatives found in the community.

A Member asked, if integration was vital what was being procured and wouldn’t it make more sense to procure a facilitator organisation to bring together the services. In response, it was explained that due to the European procurement rules, the contracts were due to expire so the services listed below had to go through a procurement exercise:

·         111 service.

·         Call handling.

·         Clinical validation of the calls and clinical support

·         GP Out of Hours for Staffordshire with the except of Seisdon area which is under the Wolverhampton CCG.

·         Urgent Care Centre at Royal Stoke A&E.

·         Out of Hours prison service.

·         Systems response and how it is all pulled together through the Urgent Care Board and the aligning in it with the Primary Care Board.

A Member felt that it appeared that this was an exercise to reduce A&E attendance by  ...  view the full minutes text for item 18.