Agenda item

Kathryn Magson, Chief Executive Officer, Herts Valleys CCG, to provide members with presentation.

Cllr Guest introduced K Magson, Chief Executive of HVCCG; she also took the opportunity to thank all the outside Health professionals for attending the Committee.

K Magson began by referring to the documents within the agenda pack (pg 5 – 11) provided to the Committee in advance of the meeting. She noted that this was in response to the Committee request for further information regarding the attendance of the UCC between 10pm – 7am. She noted that this information recorded how attendance varied month to month, as well as the averages attendances per hour. K Magson said that the Committee had requested at the previous meeting that this information be provided for the UCC over the course of the previous three years; she therefore confirmed that this information was contained in the agenda pack in response to this specific action point. 

K Magson went on to outline HVCCG’s strategic plan in relation to the UCC. She confirmed that HVCCG had approved the strategic outline case in July; She said that the Hemel Hempstead site had been prioritised, and that during the summer a piece of work had been commenced looking at how they design UCC’s. She referred to a review, conducted by Sir Bruce Keogh, of UCC’s across the NHS which had completed recently. This review concluded that three types of urgent emergency care that would be delivered by NHS. These were:

·         Hyper acute Stroke Units (very large tertiary centres, delivering specialists services)

·         A&E

·         Urgent Treatment centre (UTC’s)

She said that in the future, UCC’s would cease to exist. HVCCG therefore had a responsibility to resolve this, and commission according to the new national specifications within the next two years. She said they had been developing an urgent care strategy over the summer, specifically trying to develop what an UTC look like over all sites in Herts Valley, with Hemel being the first of these.  She said that this work had been completed, and taken to Commissioning Executive last month, and they were now in the process of engaging with the working group (which was due to meet on 28 September), with a view to ‘bottoming out’ what that specification would look like for Hemel. She said that the development which had been completed would be taken to the working group. K Magson said that the working group consisted of patient representatives and those who had a particular interest over the years, GP’s and Consultants from the Trust. She said that the aim would be to take the outputs from that group back to the Clinical Executive Committee again, and then there would be another discussion, in the form of a public consultation in the coming months. She confirmed that HVCCG had taken the initiative to submit an early adopter bid/expression of interest to become one of the first waves of UTC’s. They considered that this would be an excellent opportunity for the Hemel site. She said that HVCCG were very much at the design stage, whether or not they were successful, they would continue to work along this approach, as to what urgent care in Hemel should look like, and would welcome all input in doing so. She said that over the coming months, they would be in a much firmer position what the solution could potentially be, and the steps that they may need to take to do that. She also wanted to highlight that the West Herts Medical Centre was contracted to be re-procured, the contract had expired and had already been extended. They were trying to align this strategy so that the solution included ensuring a front door that had clear signage to the services that patients required. She concluded that this was, in essence, what had taken place since the Committee had last met. She was happy to take any questions.

Cllr Guest thanked K Magson and asked the Committee if they had any questions. Councillor England said that in 2009 it was said that UCC would be a 24 hour service; he said that this was a very high profile issues. He said that it did not appear that they were getting clarity about whether this would continue. K Magson that the same issues remained from the previous meeting about work force, which she highlighted was a national issue. She said that as part of the design process, they would need to work with the designers, looking at all options, and see what compromises could be made between what was affordable and what was possible with the workforce available. Following Cllr England’s query, K Magson confirmed that HVCGG were required to redesign all urgent facilities to new branded solutions within two years. D Evans added that when they meant urgent care, they were also looking at urgent care within primary access, such as collections of GP Hubs, whether they be virtual or physical in the local area. D Evans said that when they talked urgent care centres, sometimes this would be a building, other times it may be urgent access to a GP in a practice that is open late. He said it was just clarity about the service provided, not the scale of the building; He said that they wanted to ensure that there was access that met the needs of the right people at the right time. D Evans added that the answer to urgent care was not just building; he said that this was part of the design. He said that they were committed to ensure the right urgent care for Hemel.

Cllr England asked HVCCG if they could be very clear to everyone that they are not able to offer a 24 hour service in Hemel. K Magson believed that they had been, but was happy to reaffirm this if the Committee considered this necessary.

Cllr W Wyatt-Lowe said that he wanted to investigate the nature of users at night of the UCC. He asked the following 4 part question:

·         How serious they are?

·         What is the potential for diverting people from Watford, if correctly advertised?

·         Will the UTC have the capability of dealing with some mental health issues?

·         Were there any serial users?

K Mason re-iterated that she and the Board of HVCCG were absolutely focused on developing an urgent care strategy for Hemel, and that they would not have submitted the bid to become an early adopter for UTC’s if they were not.

She said there was absolutely the opportunity to divert, and that they did not need a long term strategy to do this. She said that following a meeting with the Ambulance Service, a new plan had been designed to encourage ambulances not to drive past, and instead maximise the facilities at Hemel UCC and St Albans. This pilot had been launched this week, was being monitored, and they would be meeting within a month to review this.

K Magson said that as there was a new facility presumably Dacorum Mental Health Centre she believed that this commitment was already quite visible

After seeking some further clarification about the final question from Cllr W Wyatt-Lowe, K Magson said that the Ambulance Service was in the process of working with GP’s on managing frequent users, including their care plans. She said that there was a joint team across the county looking at intense users that may have social care, mental health or other complex issues that resulted in them contacting 999 or using NHS facilities for reasons other than health. She said that there need to be a very long term solution for these types of individuals. In addition to this, K Magson said that they were dealing with GP where particular services appeared to be accessed more than average, and try to analyse why this may be happening. Alongside this, she noted that West Herts Medical Centre was being used by individuals that were registered elsewhere. K Magson said that discussions were currently ongoing to try and tackle this. Cllr W Wyatt-Lowe thanked K Magson. He suggested that more illustrative cases be paced on social media for public awareness of ways to access urgent care. Cllr Guest asked K Magson if HVCCG would be able to do this – K Magson confirmed this.

 Cllr Taylor made two points; Firstly, he noted the reports submitted by the HVCCG that supported their presentation, and suggested it would be helpful if a table of acronym could be included in the future, for easier understanding.

Secondly, he observed from his own experience, that the urgent care unit at Luton & Dunstable Hospital (L&D) appeared to be particularly efficient. He asked for confirmation that the HVCCG were not trying to “reinvent the wheel”, or being isolated, and were liaising with other Trusts to learn from their successes, and if this would work for West Herts. K Magson confirmed that this approach was being taken; she said that L&D was a high performing A&E Trust, and that West Herts were currently trialling a number of best practices from there. She went on to outline some of the ‘streaming’ that was currently ongoing, this included Nurse-led streaming at Watford Hospital, with the goal to increase this to 53% from 20%. They believed that this was an appropriate goal for the patient flow there. In addition to this, a GP was going to be placed in the ED at Watford as from the following week.

Cllr Timmis firstly endorsed Cllr Taylor comments in respect acronyms, and re-iterated the need for an explanation of the acronyms to be provided in the future. She went on to note the plans for the forthcoming, and newly named, UTC. She observed that although this all sounded very positive, there were also a lot of unknowns. She wondered if the treatments currently taking place at the Hemel UTC would continue to be embraced, such X-Rays, scans, endoscopy and podiatry. D Evans said that as part of the UTC’s national plans, there was a minimum level of services required in order to call yourself such. D Evans said that some of these would have the ‘back-up’ facilities set out by Cllr Timmis. He said on 28 September, a session would be taking place, looking at the clinical model that supports the services in addition to the UTC; this was with the purpose of taking the pressure away from A&E in Watford hospital. He said that they did not know yet what the national requirements would be, however the purpose of the discussion on 28September was to try and develop the right clinical model, with GP’s & consultants being invited along. Following Cllr Timmis clarification, D Evans confirmed that this discussion was not a public consultation; it was a working group for a project. However, they would be going out to the public in October with the final outcome of that discussion. 

E Glatter asked D Evans about a statement he had previously made, that it did not matter where the UTC was, and that buildings were not important. However, she said that if back-up services such as X-Rays, were needed, then she thought that buildings were required for UTC’s – she would like clarity on this point. In response D Evans said that not all urgent treatment required. In response, D Evans said that there was a breath of urgent care which took many forms, such as GP’s, pharmacists - it did not always require back-up services. He said that the focus was on how primary care could be an important part of delivering urgent care. He said that there could be confusion between urgent care and A&E. E Glatter noted this, although expressed concern that locating back-up services across Dacorum could present accessibility issues, e.g. those without a car would have more problems getting buses to different surgeries in Dacorum as there may not always be a direct bus route. This problem was avoided when all services were located in one place in the centre of town. K Magson noted this concern, although considered that this was getting into the detail, which was why it was necessary to liaise and collaborate with a range of stakeholders when designing the new UTC.

Cllr Hicks asked if the diversion of ambulances from Watford to Hemel proved a success, would this pave the way to the centre being returned to 24 hour care. He also asked if someone were to present themselves at the UTC, but required A&E, how would they get there. In response, K Magson said that she was not blocking the question, however considered that this was a detail that would be part of the ongoing design process – this would include opening times. She also confirmed that there were existing protocols surrounding the transfer of urgent care patients to A&E (EG from GP surgeries) which would be put into place.

Cllr Guest said that she would conclude up this item with two final questions; she said that at County Council Health Scrutiny, when the urgent care centre was closed overnight because of GP shortages, the idea of nurse led care was suggested – she asked if this model was being considered. K Magson confirmed that it was. Cllr Guest also asked when would HVCCG know more what the UTC would look like. K Magson said that planning meetings would be taking place between now and November, therefore they should have an update for the Health Scrutiny taking place in December.

Action Point: K Magson to provide Committee with UCC/UTC update within ‘HERTS VALLEY COMMISSIONING UPDATE’ agenda item of 13 December 2017.