Agenda item

The report of the BNSSG CCG Area Director (North Somerset).

The BNSSG Area Director (North Somerset) introduced the report on the proposed changes at Weston Hospital, including the two options for the new model of care at the hospital which would enable between 22 and 114 extra daily procedures. The two options were summarised as:

“Option 1 - Patients in ambulances (other than care of elderly patients) who may need more than 24 hours specialist medical inpatient care are taken straight to another hospital”.

“Option 2 - Patients in ambulances are taken to Weston as they are today and assessed. If they need care that is best delivered elsewhere, they are transferred to another hospital.”

Requests for clarification from Members were as follows (with responses in italics):

·       Why would there need to be a transfer if patients needed care for longer than 24 hours? The 24-hour period allowed for a thorough clinical review to determine whether there was a need for further ongoing treatment in specialist units. Examples of this were patients with heart problems, respiratory ailments, liver failure, complex gastrointestinal issues etc.

·       Details on the types of procedures envisioned under the new model. Hip and joint operations, eye, breast cancer, gastroenterology, emergency surgery, urology and gynaecological surgeries.

·       How dependent on capital investment were the plans for option 2? Much could be achieved within the current services – modelling indicated that changes to non-elective services could release up to  26 beds for planned care work.

·       What assurances did these options give for the long term plans for the hospital? Option 1 would bring risk to recruitment and retention of staff; Option 2 would ensure that no patients were diverted outside of existing networks. There would also be more access to medical investigations early on, which would provide increased job satisfaction for staff.

·       Would there be a redeployment of staff due to the increased triage at the start of the patient journey? There would be little change in terms of the nursing workforce, although there would be a change for consultant practitioner roles as well as the therapy workforce.

·       How had calculations on capacity and use of the hospital throughout the year been done? 2019/20 had been used as a baseline, plus allowing for demographic growth.

The Chairman called for an adjournment for procedural clarification.

Meeting adjourned 14:53

------------------------------------------------------------

Meeting restarted 15:12

In considering the proposed model of care, it was noted that the Panel had been asked to form a view on whether the proposed model and two delivery options would constitute substantial variations. Although a substantial variation determination would necessitate formal consultation both with Panel and the public, Members noted that the Clinical Commissioning Group was committed to further public, staff and panel engagement on the proposals regardless of the Panel’s determination.

The Panel also noted that, although delivery Option 2 was strongly favoured by the programme’s Clinical Design Group, the evaluation process was still underway and a decision on the preferred approach was due shortly (assuming the HOSP supported the proposed criteria included in the covering paper). Both Options 1 and 2 would involve significant additional capital investment and were therefore dependent on funding streams becoming available. 

The Panel nevertheless took the view that Option 2 did not represent a “significant” change but rather an ‘evolution’ of the service, delivering improvements including treating more emergency cases at Weston, reduced emergency ambulance journey times and reductions in the number of non-elective beds displaced to neighbouring hospitals.   The panel also indicated it provisionally was supportive of option 2, if the benefits outlined in the report around increased access to local elective treatment were realised.

The Panel considered that Option 1 would however constitute a substantial variation in service since it would not deliver this anticipated evolution of services at the hospital required to meet the projected needs of the local population.    The panel stated they were not supportive of option 1 and asked the CCG to consider dropping this option when the evaluation process concluded.

Resolved:

1)    that it be determined that the proposed Option 2 does not constitute a substantial variation;

2)    that it be determined that Option 1 does constitute a substantial variation, but, as this option is not in the best interest of the local population, this option should be dropped;

3)    that the Panel expects that any outcomes of engagement and evaluation meetings be shared with it;

4)    that the draft evaluation criteria proposed to be used to assess the options be supported; and

5)    that the panel would be supportive of helping with engagement of the public and that the Chairman determine with Panel Members how it can best do this.