Agenda item

Report of the Area Director - North Somerset BNSSG Clinical Commissioning Group.

The Area Director – North Somerset (BNSSG CCG) and colleagues from the CCG and University Hospitals Bristol and Weston NHS Trust (UHBW) gave a presentation addressing four key themes that the Panel had requested in an agreed one-year review of the implementation of the “Healthy Weston” changes to health services.  It was noted that although the implementation had commenced in Spring 2020, progress had been impacted by the pandemic.

The Area Director opened the presentation by highlighting some contextual developments since the start of implementation, including the merger between UHB and Weston Area Health Trust (WAHT), the impacts of the epidemic and the commencement of the second phase of Healthy Weston.

Andrew Hollowood, Consultant Surgeon and Clinical Lead for Strategy, gave the second part of the presentation addressing Theme 1: the staffing position for urgent and emergency care and the prospect of sustainably returning to a 24/7 rota (including the impact on other specialities and services).  He reported that there had been little improvement in the recruitment position.  Whilst the merger had delivered greater stabilisation of the existing workforce, he said there was no foreseeable sustainable prospect or rationale for returning to a 24/7 rota.

The Area Director (BNSSG CCG) gave the third part of the presentation addressing Theme 2: progress in recruiting primary care staff for the new front door model for the A&E.  He reported on a number of initiatives around the digital offer (eg Push Dr), redirection of suitable patients to the Clevedon Minor Injury Unit, a six-month pilot involving Sirona Care and an eight-week pilot involving the secondment of a GP with special interest in frailty. 

The Area Director also covered the fourth part of the presentation covering Theme 3: evaluation of the impact and outputs of the mental heath community crisis and recovery centre following the setting up of the new service in Spring 2020.  He highlighted the temporary redeployment of the team to provide a telephone service in May 2020 due to the impacts of Covid-19, with reversion to the original service model (Safe Haven Centre) in February 2021.  He also provided a break-down of the patients seen during this time.

Andrew Hollowood gave the fifth part of the presentation covering Theme 4: the number of people transferring to care elsewhere in the health system and their experience and outcomes.  A breakdown was provided of numbers attending or transferred to the Bristol Royal Infirmary, numbers of children transferred to other care providers and the number of patent safety incidents related to A&E transfers (there were no serious incidents reported), together with information about patient satisfaction. 

In summary, the Area Director highlighted the following points:

·       the unprecedented impacts of the Covid-19 pandemic;

·       the lack of a clear rationale suggesting a return to 24/7 A&E staffing would improve patient outcomes;

·       progress bringing more primary care capacity to the hospital “front door” and the more active role of community services;

·       progress in implementing the Safe Haven service; and

·       the stable number of patients transferring to other hospitals as a result of the changes and the robust protocols for overnight transfers

Members received the following responses to comments and queries raised:

(1)        What were the main blocks to recruitment at Weston General (Covid-19, Brexit or the Hospital’s reputation, pay and conditions)) and were Bristol hospitals less or more affected? – This was a significant national issue affecting the whole sector.  The focus for UHBW was on creating a more attractive recruitment and retention offer.  There was scope for some incentives and the ability to offer joint appointments across both locations but them in a better position in a challenging environment.  

(2)        Were there any plans to widen the opportunities to work across both locations (nursing for example)? - This was the fundamental aim of the integration process, such that there would be single services straddling both locations with single leadership and opportunities for staff to move across both locations.  Whilst the pandemic had affected progress in some areas, there had been significant successes in others due to more integrated working (such as in Intensive Therapy Units).

(3)        What was the long-term vision for the hospital and how could residents be assured that services would not be degraded going forward? – It had to be a dynamic and vibrant vision, focused on the needs of the population whilst providing a sustainable future. Current and future changes were about creating a new, exciting model that better and more sustainably delivered for the population and for its staff. Far from reducing services, the aim was to increase the numbers of patients using the hospital.

(4)        Had the pilot scheme involving the secondment of a GP specialising in frailty been a success and if so, was this likely to be implemented permanently?  How were Care homes selected to take part as some were apparently unaware of the scheme? – The pilot was considered a success and the CCG was looking to strengthen the wider frailty offer by recruiting specialist GPs going forward.  There were a number of factors that had influenced the choice of care homes including scale and circumstances where it was felt that interventions could work upstream to avoid hospital admissions.

It was agreed that the Area Director provide an update to the next meeting of the Panel on progress with the recruitment to and development of the integrated frailty and care home model.

(5)        With respect to usage of the Safe Haven service, what was the reason for the disparity in the numbers of patients from North Somerset and South Gloucestershire accessing the service – It was always intended that the service would be focussed on the North Somerset footprint but in order to support a capacity issue in South Gloucestershire during the first phase of the project, appointments were made available.

(6)        Concern that investment in crisis mental health services should not overlook children and young people – reassurance was given that additional investment was going into children’s services in parallel with the Safe Haven centre.

(7)        How would crisis mental health services be scaled up to address the likely surge in mental health issues associated with the pandemic? – A first priority of the introduction of the integrated care system model from April next year was to develop community mental heath offers at locality level, supported by additional investment ramping up over the next three years.

(8)        What was the reason for the small increase in the numbers of patients transferring to care other hospitals in the health system in 2019? – A response was not possible at this time and would be provided in writing in due course.

(9)        What were the consultative arrangements for phase two of Healthy Weston?-  Proposals were currently being worked up by a group of senior clinicians and the due statutory consultation would occur should these proposals include significant service changes

Following discussion about next steps, it was:-

Concluded: that a Panel working group be established to consider the integration plan (integrating Bristol hospital and Weston General to form a single integrated Trust)