Agenda item

This report sets out the model of care for Adult Community Services which NHS Medway Clinical Commissioning Group (Medway CCG) is planning to re-procure. There will be seven key changes to services for local people which have been developed as a result of engagement with clinicians, staff, patients and local residents.

In January 2018 the Health and Adult Social Care Committee agreed that the changes presented constituted a substantial variation to services.

Discussion

Extensive public engagement had been undertaken in 2017 and earlier in 2018 with the public, clinicians and staff. This had assisted in the design of the revised model for the provision of community health services. The Case for Change, previously presented to the Committee in January 2018, had been updated to reflect revisions to the model.

Seven key changes would be presented as part of further public engagement planned for September and October. These would aim to make services less fragmented and more joined up with more services to be provided locally and closer to where people live. Improvements to multi-disciplinary working would be proposed as well as the creation of a single point of contact for patients. The process was about redesigning services and providing them in a different way rather than reducing them and to reduce the impact on secondary care by strengthening support provided in the community.

The Committee was asked to provide feedback on the seven key changes set out in the draft public consultation document. The engagement would be widely publicised, with 20 focus groups being used to target hard to reach communities. The CCG would also ensure that housebound people could have a say. There would also be three public meetings on 20 September 2018, 8 October and 19 October 2018, details of which would be circulated to the Committee. NHS England had been positive about the proposed approach and had recommended some minor changes to the draft document.

A number of questions were raised by Member of the Committee which were responded to as follows:

Centralising of Services and related challenges – In response to a Member question about the timescales for the proposals, the capacity of the healthcare system for the centralisation of services, what work was being undertaken with staff to prepare them for the changes, the technological barriers to change and concern that it would be impractical to only provide services from a small number of locations, the Committee was advised that the CCG would be looking to provide the most common services within each of the six localities. Over 70% of clinical appointments currently took place within two localities – Gillingham and Rochester. It was envisaged that the proposed changes would actually increase the number of appointments taking place within the other four localities, with many patients having to travel less distance than they currently did. 

In relation to the workforce, there was a need to look at a revised model. Work was taking place with existing providers to upskill staff with regards to long term conditions. Procurement was due to take place from January 2019 with a go live date of April 2020. It was anticipated that the proposals would reduce overall patient travel and it was noted that 78% of the population would be within a 20 minute public transport journey of one of the healthy living centres. It was recognised that IT systems did not interface with each other and there was a need to look for more innovative ways to deliver the model through different IT applications.

Changing how services are delivered – There was recognition across the NHS that it could not continue to deliver services in the same way. The average age for a woman in Medway to have three or more long term health conditions was 59, which was significantly worse than average. This evidenced the need to change how services are provided in Medway. There was a need to create local access within the six hubs that would not just involve community services. Work was being undertaken with Medway Maritime Hospital and with Public Health to undertake health needs assessments within those localities to ensure that the services developed would provide services in different way and provide better value for money. In relation to IT, different  GP systems were now able to interface with each other.

Engagement Statistics – It was requested that the Committee be provided with a breakdown of the engagement undertaken to show, for example, the number of disabled people or people from a black, Asian or minority ethnic background who had taken part in the engagement activity to date.

Decision

The Committee commented on the proposed changes to adult community services and noted the plans for further public engagement during September and October 2018.