To receive update reports on the New Health Deal for Trafford from representatives of Trafford CCG, UHSM and CMFT.

The Committee welcomed Sara Roscoe (NHS England), Silas Nichols (Deputy CEO, University Hospital South Manchester (UHSM) Foundation Trust), Mary Burney, Dr Jon Simpson and Stephen Gardner (Central Manchester Foundation Trust (CMFT)), Julie Crossley, Ellin Swanborough, Gina Lawrence and Dr Nigel Guest (Trafford Clinical Commissioning Group (CCG)). Dr Nigel Guest delivered the presentation entitled ‘Trafford New Health Deal, Review of Urgent Care Centre’ which had been provided in advance of the meeting within the published papers.

In response to a query Dr Nigel Guest confirmed that the Integrated Care Redesign Board (ICRB) had continued to meet explaining that as they were part of the original governance structure they would be required again in due course. In response to a query regarding the audits carried out of the impact on neighbouring A&E’s officers assured members that the data was robust. Silas Nichols said that the main impact was on the A&E at UHSM. He added that over the past year attendances had unexpectedly increased from 250 to 275 per day; and sometimes higher (in particular Sundays and Mondays). However, he felt this was demographic driven rather than directly a result of the changes at Trafford; but increased admissions had impacted on Trafford CCG’s budget. In response to a query Silas Nichols explained that delayed transfers of care sometimes resulted from a hospital’s own systems. There was a need to ensure patients were only admitted for a short time, and resolve ongoing problems of access to care packages. Stephen Gardner said that CMFT continues to receive a payment in addition to tariff for the Urgent Care Centre service, and although this is much smaller than it was originally, it still means that this funding is not available to develop community-based services. He added that performance at CMFT was comparatively good but there was a need to deploy staff where skills could be used.

Members raised concerns regarding mental health provision. Members noted that they had recently visited several Manchester hospitals and staff had raised concerns that it was not acceptable for patients with mental health problems to be waiting excessively within A&E departments. Dr Nigel Guest advised that Trafford CCG commissioned Greater Manchester West, which members agreed provided a good service to UHSM and Trafford General Hospital. Members noted that there were challenges in mental health services in Manchester at the present time and Manchester City Council’s Health Scrutiny Committee were aware of this. Dr Nigel Guest added that a major review of mental health services across Greater Manchester would commence once Greater Manchester gained devolution powers in respect of Health and Social Care.

Members discussed the data provided within the report and asked for clarity on a number of points. Officers confirmed that the statistics provided in respect of urgent admissions were all patients from Trafford; and a reference to 2005 in report should have read 2015. Members agreed that there were issues with the waiting room at the A&E at Manchester Royal Infirmary (located within CMFT). Dr Jon Simpson explained the reasons adding that adjustments were planned He referred to the impact of emergency admissions. He also stressed the importance of patients accessing the right care in the right place and explained that more work was required in order to understand the barriers to local services. In response to a query Silas Nichols said that increased admissions made it difficult for UHSM to maintain patient flow; and that he would update the Committee on this at its next meeting.

Members discussed the Criteria for moving to Model 3 which proposed that the Urgent Care Centre at Trafford would eventually become a Minor Injuries Unit. A member read out an extract of the letter from the Secretary of State in 2013 which stated that the move was dependent on ‘neighbouring A&E’s consistently meeting their waiting time standards’. Members sought assurance that officers did not intend to move to Model 3 at the current time. Gina Lawrence advised that she could not give a timescale about a move from a doctor led model to a nurse led model. Data had been collected and provided to the ICRB as the appropriate body to oversee this. An audit and workshops would follow. She stressed the importance of getting it right and communicating clearly to residents and partners; explaining that the next steps would be provided to the next meeting of the Joint Health Scrutiny Committee. Members agreed that they did not think it was appropriate to move to Model 3 at the current time and agreed to delegate responsibility to the Chair and Vice Chair to make a referral to the Secretary of State should this happen prior to the Committee’s next meeting.

A member queried whether a wider range of services were being considered in addition to a nurse led model and noted the reference to ‘other practitioners’ within the report. Officers responded that it was proposed to include social care professionals in addition to nurses. Dr Jon Simpson described how the proposed changes would be made, assuring members that they would be carried out in a safe way. He stressed the importance of making better use of the skills of NHS staff across Greater Manchester and that many patients using the Urgent Care Centre at Trafford did not require medically trained staff. Members discussed the recruitment and retention of NHS staff including a shortage of nurses and issues around the introduction of a new contract for junior doctors. Officers advised that the nurse shortage was primarily Band 5 and UK wide recruitment was planned. Officers said they did not know what the impact of the new deal for junior doctors would have as yet, adding that Monitor planned to introduce a pay cap on agency workers which may also affect staffing.

A member noted there was a lack of qualitative data and patient feedback within the report. Mary Burney advised that ‘comment cards’ were placed within A&E departments and a Quality Assurance Team was in place which were available for face to face conversations with patients as required. Members discussed the recent visits they had made to A&E departments and noted that a visit to the Urgent Care Centre at Trafford had been suggested. Members agreed that it would be useful to visit the Urgent Care Centre, and Trafford Councillors would also be interested in visiting the adjoining Walk in Centre.

Decisions:

1. To thank Officers for attending.

2. To note the information on the Orthopaedic Centre.

3. To note the report on the Winter Resilience Plan.

4. To note that a report on the Falls Service would be circulated for information to members of the Committee later in 2016.

5. To endorse the Committee’s decision made at its 2 February 2016 meeting: “The Committee requests that the services and opening times of the Urgent Care Centre are better publicised to Trafford residents and that the North West Ambulance Service, Trafford GP’s and pharmacists are reminded of the possibility for referral to the UCC where this is appropriate.”

6. To request that officers provide to members of the Committee copies of the recent communications regarding the Urgent Care Centre (UCC) including those made on social media and the letters sent to GP’s and Commissioning Centres. To recommend that a variety of communications are used to promote the UCC including social media carried out correctly combined with more traditional forms of communication.

7. To request that Silas Nichols provide a written update to members of the Committee on the expansion of UHSM A&E department.

8. To consider the progress of work on the expansions of the A&E at UHSM as a standing item on the agenda for future meetings of the Joint Health Scrutiny Committee.

9. To arrange a visit for members of the Joint Health Scrutiny Committee to the Urgent Care Centre at Trafford General Hospital; and to the Walk in Centre for Trafford Councillors if required.

10. The Committee agreed to continue receiving performance reports on the implementation of the New Health Deal for Trafford. These reports will include Attendance and Admissions performance data for the three neighbouring accident and emergency departments and the Trafford Urgent Care Centre.

11. The Committee note the data provided within the report. The Committee note NHS plans to progress the proposals via the ICRB and further note that clinical models for the future of the Urgent Care Centre will be presented to a future meeting of the Joint Health Scrutiny Committee. The Committee note that the timescales for this process will be outlined at its next meeting.

12. The Committee notes that if the Urgent Care Centre is proposed to be closed or substantially downgraded before the Accident and Emergency Department development at UHSM is in place, the Committee may consider a substantial variation referral to the Secretary of State.

13. Members agreed to delegate responsibility to the Chair and Vice Chair to make a referral to the Secretary of State should this happen prior to the Committee’s next meeting.

14. The next meeting of the Committee is expected to be scheduled for June 2016; the date of which will be confirmed in the new municipal year. The Chair requested that if it is necessary to submit reports after the legal deadline for publication of the agenda; that they are submitted no later than 12 noon of the Friday prior to the meeting in order to allow members adequate time to read all of the information in advance of the meeting.