Agenda item

NHS Medway Clinical Commissioning Group (CCG) wants to transform the way adult community health services are delivered across Medway, so that they are less fragmented, more joined up and with more services within local communities, closer to people’s homes.

There are seven key changes to services for local people which have been developed as a result of initial engagement with patients, clinicians, staff and local residents. In August 2018 the CCG consulted with the Committee on these seven key changes.

Following this, the CCG then undertook patient and public engagement during September and October. The report outlines the approaches taken during this engagement, the feedback received from local people and describes what the CCG will do to respond to the findings.  

Discussion

The Committee was provided an update on progress since the previous report presented in August 2018. Engagement had taken place in late 2017 to early 2018 with patients, the public and staff. Seven key changes to community health services were identified following the engagement with resulting plans having been shared in August. This had included the publication of a document detailing the seven key changes.

Further engagement was undertaken in October 2018. This included 276 responses to a survey aimed at clinicians, staff, patients and local residents. It had been ensured that housebound patients had the opportunity to participate. The majority of survey responses were from patients. The engagement also included discussions with GPs and practice managers, Face-to-face meetings, focus groups and interviews. A total of 400 conversations were undertaken with a range of stakeholders. An independent research company had been commissioned to analyse findings. The analysis showed that most people supported the proposed seven key changes and felt that they would improve services. The most important factors identified were the need for an increase in multi-skilled nursing, therapists supported by specialist teams and quicker response for patients with more complex and long term conditions. It was generally considered that the proposed changes would amount to a fairer way of delivering services with better access and co-ordination of care. 

Concerns raised included that changes may not be implemented until after the procurement that was due to take place in 2020. Medway NHS Clinical Commissioning Group representatives confirmed that changes were being made ahead of the procurement. One example was enabling clinical teams to work in a different way. GPs were working with health and social care to support people with complex and long term conditions and existing providers were making changes to service access, including introduction of central booking systems and co-ordination. Following concerns raised about centralised booking, relevant provider requirements would be strengthened in the procurement.

Workforce concerns had also been raised at the public engagement events. This included concern that there would not be enough staff. A Workforce Strategy was being developed which would help to address these concerns. A Workforce lead was working with all providers to address challenges and identify gaps in the workforce. It had been identified that the workforce needed to be better trained to enable identification of mental health issues and provision of better advice and signposting. The integration of community services with other services would be strengthened as would links with talking therapies.

Work was taking place with Medway Community Healthcare to ensure staff had skills to provide a wider range of interventions to patients with multiple long term conditions. The importance of workforce would also be strengthened in the tender documents. The CCG was investing an additional £1.5million to support revised community health services model.

A Committee Member was concerned that relatively few staff had participated in the engagement and that patients managing their own conditions had received the smallest support of any of the proposed seven key changes. The CCG had started to deliver some of the key changes required but the Member was concerned that the CCG was still planning to undertake a large scale reprocurement. She felt that existing providers would be at a disadvantage and that the exercise would cost more than the £1.5 million of funding being made available by the CCG. Medway Community Healthcare (MCH), one of the existing providers, had received legal advice suggesting that there was not a need to recommission services, which was contrary to the advice that the CCG had received. The Member considered that the CCG should innovate and not spend time on what she considered to be unnecessary procurement. It was clarified that the Chairman of the Committee, Vice-Chairman and Opposition Spokesperson had recently met MCH, at its request and that a number of concerns had been raised.

The Deputy Managing Director of the CCG said that it was continuing to review the situation but was currently of the view that it needed to undertake the procurement. In relation to staff participation in the engagement, the CCG Senior Programme Manager said that there had been significant staff participation at previous engagement sessions and that staff had been present at public engagement events. Staff from existing providers had been positive about the proposed changes.

A Committee Member emphasised the need for continuity of service provision and that although procurement needed to be considered, she was concerned about the scale being proposed. Another Member asked what the target had been for staff and patient engagement. The CCG representatives said that the challenge of service continuity was acknowledged. Community Services were not working in isolation but as part of the Medway Model. This would help to ensure that areas of duplication were addressed and the use of resources maximised. There had been no specific target for the number of people that the engagement would reach. As the number of responses to surveys was historically low, other engagement techniques, such as targeted interviews and focus groups had been used. Feedback had been obtained from 400 patients. It was acknowledged that there had not been as much feedback from staff as had been hoped, but overall, the CCG was satisfied with the engagement undertaken.

It was requested that the Committee be provided with further data in relation to the engagement undertaken and for this to include total figures for all engagement undertaken in the last two years. It was also requested that information be provided on the demographics of the people who had taken part in the engagement.

Decision

The Committee:

i)    Noted the findings from the public engagement during September and October 2018 and the CCG’s responses and actions taken as a result.

ii)   Requested that further data and statistics in relation to public engagement undertaken to date be provided to the Committee.