Minutes:
The Chairman welcomed James Blythe, Director of Commissioning and Strategy to the meeting. Mr. Blythe was attending the meeting to provide an update on the work of the CCG on behalf of Karen Parsons, Chief Operating Officer, who was unable to attend.
Community Hospital Services Review
There had been a number of changes over recent years at all of the five community hospital sites. The current challenge facing the CCG was around the appropriate service model and the sustainability of services in the longer term.
The CCG had a contract for in-bed services at four of the sites: Molesey, Leatherhead, Epsom and Dorking. Beds had been moved to Dorking from Leatherhead to ensure safe levels of staffing.
A review of the service had commenced in March this year. It involved observation work in each hospital by an experienced clinician, a review of activity and outcomes and what other models were used around the country. At the start of the review process a Programme Board had been convened to oversee the review process. The Community Hospital Review Programme Board was chaired by Dr Jill Evans and included two members of Surrey County Council’s Well-being and Health Scrutiny Board, County Councillor Tim Hall and Mole Valley District councillor Lucy Botting.
A draft review report had been published in August. In particular, Mr. Blythe highlighted that the draft report considered how the rehabilitation service should be run and set out a number of options for the future configuration of in-patient beds. In summary, the general recommendation was that beds were sustainable on three sites and the options for their configuration (which would be the subject of further consultation) were:
· In-patient services to be retained at Epsom, Moseley and Dorking
· In patient services at Moseley to be moved to Cobham (built in the 1990s, this facility had accommodated in-patient beds in the past and there was likely to be demand for facilities in that locality in the future)
· In-patient services at Epsom to stay at their current site or be co-located on the Epsom Hospital site (this had been piloted last year when the current site had been under refurbishment and was linked with the Hospital’s estates review). If some beds from West Park were relocated then consideration would be given to the services left on the site. If all beds were relocated then the site would be potentially vacant and available for redevelopment but the future of the site would be a decision for NHS property services.
· In-patient services at Epsom and Moseley to be moved as stated above.
Each option included the retention of Dorking because of its service catchment area, particularly south of Dorking, and its out-patient services. None of the options included beds being re-instated at Leatherhead and the in-patient ward would be closed permanently. The future of the Leatherhead site lay in the development of the site for out-patient service delivery as a planned care hub. This was because of the excessive costs and unsuitability of the Leatherhead site for reinstating in-patient bed services and the availability of other suitable sites (NEECH, Epsom and Cobham) in the Epsom locality.
The draft report was due to be considered by the CCG’s Governing Body on 25 September 2015 and the options (three sites with a number of options on configuration) would go forward for public consultation in October. Services were likely to be under pressure over the winter months and so changes were not likely to be implemented until spring next year.
A number of public engagement events had been undertaken up to this point involving several hundred people and the CCG had received relatively strong feedback in those areas affected by the proposed changes. Leagues and Guilds of Friends had been very helpful but it was disappointing not to have had slightly wider representation. The CCG was working hard to publicise the consultation and encourage engagement.
It was confirmed that ancillary issues had been taken into consideration such as understanding the geographical location of long term patients and the impact of travel time. Clinical safety and sustainability of services were the CCG’s first priority.
CCG’s Financial Position
The CCG incurred a £10.7m deficit in 2014/15. This was the result of two main factors: overspend on planned care services and accounting allocation adjustments. Two thirds of the deficit was the result of overspend on planned care services. The CCG had identified a high level/demand for such services. Some demand on planned care had gone up by 6.2% and the CCG had identified a 5% recurring growth but was only funded for 1% – 2%. Therefore the CCG already faced significant cost pressures going into this year. A savings programme had been drawn up which hoped to save £12.8m but, even with those savings, the CCG faced an £18m deficit for 2015/16.
Work was being undertaken on a financial recovery plan for 2016/17. A deficit of £8m was projected for 2016/17. It was hoped to break even by the end of 2016/17 so that there would be no deficit in 2017/18. The seriousness of the situation had been the subject of scrutiny by NHS England and the CCG was currently under directions to support the CCG with in its financial recovery plan to achieve a financial balance in 2016/17. The CCG had been directed to appoint a Turnaround Director and a Capability and Capacity review had been commissioned by NHS England.
Mr. Blythe attributed the deficit to the CCGs aim to transform services rather than cut them. The CCG was working with GPs to try and reduce system costs and looking at proactive services to prevent acute admissions. Organisational change had been challenging with the move away from PCTs and the Better Services Review but the CCG had been pursuing its vision. There were no cuts in the in the current savings plan but if the plan was not supported or did not succeed, more aggressive measures might have to be considered. Options regarding the Stroke Unit were currently being worked through. No decisions had yet been taken but the CCG would ensure appropriate services for the local area.