Agenda item

The Select Committee will receive an update from the Clinical Commissioning Group (CCG) on current issues.

Dr Ian Orpen addressed the Select Committee. A copy of the update can be found on their Minute Book and as an online appendix to these minutes, a summary of the update is set out below.

A&E performance

Local system performance against the A&E waiting time target (95 per cent of attendees to be seen within four hours) was 74.5 per cent in February. Across England there continues to be extremely high demand, compounded by the recent adverse weather, and this is putting local health and care services under significant pressure. The CCG, RUH and Community Providers across B&NES and Wiltshire have worked together to produce a revised Four Hour Recovery Plan which is monitored and reviewed on a weekly basis.  The plan consists of actions for both the RUH and community providers with a significant focus on reducing the numbers of delayed discharges and patients who have been in hospital for more than 21 days.

Maternity update

At November’s Select Committee meeting there was a briefing on the new arrangements being put in place to improve and transform maternity services across B&NES, Swindon and Wiltshire as part of the Sustainable Transformation Partnership (STP). These new arrangements follow the national maternity review and the publication of Better Births and Five Year Forward view. 

A shortlist of options is being co-created with service users and stakeholders by the end of March 2018. These options will be shared with the Health and Wellbeing committee once they are confirmed along with the formal consultation process which would be expected to start in September 2018.

Proposals to restrict access to three non-urgent services

Our Board met on 8th March to review feedback from our public consultation on fertility and sterilisation services and to make a decision on whether to change the existing policies. They agreed that male vasectomies will continue to be available on the NHS and female sterilisations will continue to be funded for women for whom there is no suitable alternative, long-acting form of contraception. On access to fertility services, the Board agreed that:

1. The female partner receiving treatment must be aged between 23 and 37 years.
2. The male partner of the woman receiving treatment must be aged 55 years or under.
3. The female partner receiving treatment must have a body mass index (BMI) in the healthy range for women wanting to conceive, of 19–30.
4. The male partner of the woman receiving treatment must have a healthy BMI of 30 or less.
5. Couples must have been trying to conceive for at least two years where the female partner is aged 35 years or younger, and one year where the female partner is aged 36-37 years.

Our financial position

Despite starting 2017/18 with a forecast funding gap of £11.6m, we have achieved a breakeven position at the end of the year. We have delivered efficiency savings through the hard work and dedication of all our staff and support from partner organisations.  We are also grateful to the public who are increasingly aware of the financial pressures facing the NHS and are playing their part to help reduce costs, for example by paying for over-the-counter medicines rather than getting them on prescription and only using A&E for medical emergencies. Our budget for 2018/19 is £266m but we must make at least £5.7m in savings in order to keep to our funding allocation this year.

CCG and Council integration plans

Last week Council Cabinet members and the CCG Board meet to review progress to join up our commissioning teams as one combined function.  Currently the focus is on developing the joint governance to support this change that is compatible with two very different legal frameworks. A joint workshop for CCG and the Council’s People and Communities staff was held last month to start to discuss the direction of travel and explore together the implications for day to day operations as well as more intangible aspects of work such as culture and behaviours.

Launch of local ‘3 before GP’ campaign

This week we have lent our support to the Royal College of GPs’ ‘3 before GP’ campaign which aims to get people to consider trying three things – self-care, visiting the NHS Choices website and speaking to their local pharmacist – before contacting their GP for an appointment.

Councillor Dine Romero asked if there were a shortage of midwives locally.

Dr Orpen replied that the vacancy rate at the RUH was low.

Councillor Dine Romero asked if he knew the definition of ‘essential staff’ required for the RUH with regard to the recent storm weather.

Dr Orpen replied that he did not know the exact definition referred to in the policy. He added that communication with all staff was good in the build up to the event and praised staff that did their upmost to provide as normal service as possible.

Councillor Bryan Organ asked if the programme to prepare patients physically for knee / hip surgeries is continuing.

Dr Orpen replied that it was.

Councillor Eleanor Jackson asked if he knew the average wait for an appointment with her doctor for a patient suffering with a chronic complaint. She said that there was currently a three week wait at the Hope House Surgery to see her regular GP.

Dr Orpen replied that the timescale quoted by Councillor Jackson was probably around the same for the majority of surgeries for patients wanting to see a specific GP. He added that there was not always a need for a face to face appointment and that a number of enquiries are now dealt with GPs over the phone.

He said that it is likely to be quicker, and may often be more appropriate, for a patient to speak to their doctor over the phone as opposed to a face to face appointment.

Councillor Eleanor Jackson asked if consideration were already being given to plans for flu vaccinations for the coming winter.

Dr Orpen replied that there is indeed a challenge for the coming year in terms of who receives which vaccination, re: over 65 / under 65. He said that work was underway to find a solution.

Councillor Eleanor Jackson asked if there were any problems locally with regard to ‘bed blocking’. She commented that Age UK run a programme to assist with enabling patients to return to their home.

Dr Orpen replied that when discussing plans for the discharge of a patient, complicated issues can arise. He said that these can include the patient’s level of need and the finances associated with those needs and were not simply a matter of community care capacity. He added that he was aware of the Age UK service and the good work that it does. He said that the Home First service operated by the RUH provides the similar option with support for patients who have complex needs, and that on average 25 patients a week are discharged using the service.

Councillor Dine Romero asked if there were a mechanism in place for university students to dual register at a surgery whilst studying and to remain on record at their home surgery.

Dr Orpen replied that patients can only be registered in one place, but their records at the home surgery would still contain access to the information that was in their medical records prior to them going to university and they could be seen as temporary patients while home on holiday.

The Chair thanked Dr Orpen for the update on behalf of the Select Committee.