Minutes:
Consultation on Urgent Care Centres (UCC) and Extended Hours
Janet Cree provided a short update to the consultation on UCC and extended hours. The NHS Long-Term Plan indicated long-term investment in extended opening hours. It was explained that the intention was that from July 2019, extended hours would be delivered through direct enhanced services (DES) with the expectation that the CCG continued to commission that provision through the GP primary care network. The CCG will continue to commission local hours for the first quarter of 2020.
Further guidance from the NHS was expected however, the DES was expected to further develop and this had necessitated the need to change the scope of the GP contract. Janet Cree explained that it was not possible to include consultation on DES but that the consultation would still look at extended care and that this had been the reason in part for the delay to the commencement of the consultation.
Healthwatch had been very helpful in reviewing the consultation materials and work on developing this had progressed well. This had been a large, joint piece of work and following discussions, the layout and content had been refined. Final adjustments were required and then content would be available in a variety of formats online. The documents would be in plain English and included a short, A5 leaflet, a brief overview, an easy read version of the consultation document, a poster, adverts and social media activity. It was anticipated that the launch could take place the following week, once formal assurance had been provided by NHS England. The CCG had also been in contact with the Councils communications team for guidance on how best to reach residents. It was thought that it would not be possible to send text alerts or information by text message due to both potential legal and financial constraints.
Councillor Coleman enquired about the methods by which residents might be informed of the consultation. Janet Cree explained that the consultation would last approximately seven weeks and had been slightly extended due to the Easter holiday period. Details as to the location of posters could be provided but these currently included libraries, GP practices and UCCs to ensure that service users would be aware of the proposed changes.
Councillor Coleman queried the anticipated savings, that might follow the implementation of service changes. Janet Cree indicated that this could amount approximately £600,000 each, for both changes to UCCs and GP extended hours if the proposed changes were accepted, so potentially £1.2 million. Discussing the possible cost of the consultation, it was noted that this was limited to the cost of printed materials. Janet Cree explained that the CCG had taken advice on how to raise awareness with residents as well as to ensure that the consultation document was accurate.
Referring to the length and range of any consultation, Councillor Coleman highlighted two concerns. The first, was about the consultation itself and what it was nature of the consultation, with the intention to make savings, not cuts. Secondly, the manner of the consultation. He welcomed and was encouraged by the progress of the consultation and suggested that the Board collectively undertook further work to discuss and develop a more cohesive approach to consultation for future reviews. The NHS defined what constituted a full, public consultation and he welcomed further dialogue about this. Comprehensive consultation hinged on the definition of what constituted a substantial variation in services. How a proposed change was defined influenced the level of engagement. It was important that the Council was made aware of whether a change could be regarded as substantial early on and Councillor Coleman suggested the Council’s Health, Inclusion and Social Care Policy and Accountability Committee (PAC) as a potential forum through which this could be managed. Janet Cree concurred and stated that the CCG would fulfil its statutory functions.
Councillor Coleman continued and asked that in future, the scale and scope of any proposals set out whether potential service changes constituted a substantial variation, and, whether a full consultation was required. Councillor Coleman sought agreement that such decisions would be reached through collaborative work undertaken with the Council and the PAC. He acknowledged that the Council had received notice of what the CCG was consulting upon, but that there had been an absence of dialogue as to the breadth and scope of the proposed consultation. Councillor Coleman pointed out that according to NHS guidance, the determination as to whether a change a constituted substantial variation was a matter for agreement with the local authority.
Janet Cree took the view that the CCG had sought a challenge of their consultation proposals when they had presented the issue at the 4th December meeting of the PAC, considering the specific details of the proposals. Councillor Coleman felt that there had been initial discussion about consultation details but no explicit agreement as to the scope of the consultation and this should have been the conversation taking place. Janet Cree confirmed that this had been also been the CCGs intention. Addressing a comment from Keith Mallinson, Janet Cree continued that it had always been the CCGs intention to undertake a full consultation, including consultation with Healthwatch.
Jim Grealy welcomed the progress made on the consultation work and commented that it took time to undertake consultation well. He enquired if a year-long plan was being developed to address future changes. Janet Cree confirmed that there was no intention to do this and that they would be working on a case by case basis. All changes would have an equalities impact assessment.
Councillor Coleman considered that agreeing the scale of a service change and if it was a substantial variation would determine, in turn, the most appropriate level of consultation. He suggested that this was a new way of working and that it would determine the scale of change. This would be the first stage of any discussion in attempting to achieve consensus.
Sue Spillar suggested that a public engagement strategy be developed to consider the likely impact of changes in services on residents. She enquired if the CCG were consulting on a range of possible options or would these be developed with broader co-ordination. It was noted that this would be determined and shaped by the response to the consultation.
In concluding the discussion, Councillor Coleman recapped that in future, services changes would be notified to the PAC, as part of developing how consultation on such changes be undertaken.
Supported Employment
Councillor Lucy Richardson outlined her discussions with the West London Alliance regarding the development of an improved supported employment offer for local residents. There was interest in getting help with referrals and getting people into work. It was suggested that a workshop event be facilitated with health professionals and that this could be hosted at the Town Hall. It was agreed that Councillor Richardson provide further details to Janet Cree.