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Subject to final approval by NHS London and sign off by the PCT Chair and Clinical Commissioners Chair, formal consultation on the future of Orpington health services was scheduled to begin on 16th July 2012.

 

A presentation on the proposals (i.e. what people would be consulted on) was given by the Project Director, Orpington Health Services Project and a confidential draft consultation document was tabled. A copy of the PowerPoint Presentation is attached at Appendix A.

 

A Pre-Consultation Business Case, agreed by the local Clinical Commissioners on 5^th July 2012,had been developed to demonstrate a robust, evidence- based, clinical case for change and to outline the future proposals.

 

The Project Director’s report to Members set out how it was believed the four tests for reconfiguration proposals (under the revision to the NHS operating framework in England 2010/11) had been met prior to consultation.

 

Support from GP commissioners - engagement with GP commissioners and the broader GP community had been continuous throughout the lifetime of the Project, with GP commissioners being central to the project. The project had ensured that emerging proposals are also aligned with the emerging local CCG strategy. Engagement had taken place between August 2011 and June 2012, and would continue through consultation and implementation.

 

The Orpington GP cluster had also been engaged in shaping the emerging picture at each of their meetings.

 

Strengthened public and patient engagement - the Project had engaged and captured the views and feedback of a wide range of people e.g. Bromley and Orpington residents, patient advocacy groups, Orpington hospital staff, GPs, Clinical Commissioning leads, Bromley LINks, Bromley OSC, NHS London, Bromley MPs and Councillors. Engagement took place between September 2011 and June 2012 and would continue through consultation. Engagement had been undertaken in an open and transparent process and was found by the Health Gateway Review team to be well managed, inclusive and effective.

 

Clarity on clinical evidence base - there had been strong clinical leadership throughout the Project. Various clinicians such as SLHT clinical leads, Clinical Commissioners and GPs had been involved in the project and had assisted with assessing the needs of the population currently requiring services from Orpington Hospital e.g. long-term conditions such as diabetes. The clinicians had assisted in identifying opportunities to improve the services delivered to the population e.g. co-location with specialist services, improving primary care estates, increasing independence.

 

The information and evidence collected showed a strong clinical case for a new model of care for services currently delivered from Orpington Hospital and opportunities to further integrate services to meet wider health and wellbeing needs of the local population. 

Consistency with current and perspective patient choice - all recommended approaches for consultation would result in services currently delivered on the Orpington Hospital site being transferred to alternative locations. Accessibility and patient choice had been key considerations in developing viable options for delivering services to meet local population needs.

 

Information and evidence collected indicated that the proposed changes would not have a significant impact on patient choice and in many cases would result in increased choice.

 

The Project Director’s report also advised that NHS London had invited the National Clinical Advisory Team (NCAT) to review the reconfiguration of services currently provided at Orpington hospital. The visit on 25th April 2012 included meetings with the project team, GP Commissioners, patient and public representatives, staff involved with intermediate care, and clinicians of the services to be relocated. 

 

NCAT was asked to look at the clinical safety of the proposals and whether they met the requirements for a quality local service and also to address the Secretary of State’s four criteria for service redesign.

 

NCAT agreed that there was a strong clinical case for change; however, they made a number of recommendations to strengthen the project.

 

A Health Gateway Review of the Project, carried out from 14th to 16th May 2012 assessed the Project as Amber – “Successful delivery appears feasible but issues require management attention. The issues appear resolvable at this stage of the programme/Project if addressed promptly”. Five key recommendations were made to increase the likelihood of the project achieving its objectives; these were in the Pre Consultation Business Case and were all being actioned.

 

A Health Inequalities and Equality Impact Analysis had been developed and positive impact on inequalities was expected on the well being approach being supported. 

 

There was potential for adverse impact for some people with a disability if a hydrotherapy pool was no longer provided although the report indicated that the overall benefits for population health care justified any potential adverse impact. It was also intended to review each of the NHS patients with long-term care plans involving hydrotherapy in order to minimise any potential adverse outcomes. In addition, NHS patients would be able to access hydrotherapy via the pool at Queen Mary’s Sidcup (QMS).

 

There would be some travel impacts in moving the service to QMS and the numbers of patients impacted (felt to be small) along with alternative choices to mitigate the impacts were being investigated as the next stage of the impact assessment.

 

Many benefits were also expected from a well being approach and some settings identified had been found to increase and improve access.

 

It was proposed to run the consultation for 14 weeks from 16th July 2012 to 29th October 2012. To ensure wide access and help people engage with the consultation, a number of channels would be made available including:

 

• online, via website and email address;
• telephone facilitated feedback, offering help to capture information;
• written feedback via the post;
• in person at events; and
• via an intermediary advocacy service.

 

A number of consultation materials would be produced, including:

 

• a full consultation document containing a series of questions about the proposals;
• a consultation summary document to all households in Bromley;
• a briefing outlining how different individual services would be affected by any proposals;
• poster promoting the consultation with advice on how to engage;
• freepost postcard to request a full consultation document;
• a consultation website as part of the  SE London cluster site; and
• a short film outlining the key issues.

 

In her introductory comments, the Project Director indicated that NHS London was content that consultation requirements had been met - the Committee’s consideration was the final stage in the pre-consultation process. She advised that consultation would be extended if it was necessary to make any changes resulting from the South London Health Trust (SLHT) being put into administration. The Managing Director/Director of Public Health added that GPs and the Clinical Commissioners Group (CCG) were keen for the proposals to be taken forward as it was best for Orpington. The focus was not about the SLHT but about what was best for Orpington; it was about a commissioning g process and what would be delivered for the borough - the principle of going forward was not dependent on the SLHT.

 

The Director explained that the consultation document would be provided on white paper. Councillor Mrs Manning suggested that a larger font is used and she highlighted some grammatical concerns in the early part of the full document. The Project Director explained that a short summary leaflet would be provided to all households with a tear-off slip to request the full consultation document. A summary leaflet had also been produced along with a document and questionnaire in easy read format. Members were also advised of a meeting on 7^th August 2012 for NHS clients with a disability who might be affected by proposals for the hydrotherapy pool.

 

In addition to details provided in the PowerPoint presentation at Appendix A, the Orpington Health Services Project Director provided other comments including those summarised below:

 

• a mix of care was necessary in the right places - the right set of services was necessary in the right places to meet needs;

 

• every area of Orpington has a high reliance on out patient services;

 

• it was necessary to look at alternative care pathways;

 

• there was an aim of re-developing an extended Health Centre (wellbeing centre)  to provide a range of community outpatient Services and health promoting support – a larger Centre was preferred to a smaller one (certain needs could be met with smaller Centres with other services provided in hospitals but this approach was not preferred);

 

• on proposals for sites and where to place such a development, it was necessary to undertake consultation before finalising the  outline business case for capital – a centre of excellence could be developed on a hospital site or in a high street  - there were a range of options to explore;

 

• waiting time reductions on community alternative services had been demonstrated and the development would seek to extend this approach for a new Community Health and Wellbeing Centre;

 

• a report from the National Clinical Advisory Team supported the recommendations for Orpington Hospital/Orpington health services – there were clear conclusions to support the direction of travel. Outpatient services at Orpington Hospital should be transferred to the PRU or QMS in some cases. The use of the current hospital footprint was no longer seen as appropriate, this has implications for hydrotherapy;

 

• for dermatology generally, 60% of new referrals are to community based clinics. The case mix is changing and theatre space is not adequate at Orpington Hospital and there is a desire to consolidate into one service;

 

• from a survey of 60 patients who had used an intermediate care services, a larger number of the patients preferred to have their care at home – intermediate care needs were to be supported at home under the proposed new arrangements;

 

• a clinical review of hydrotherapy did not provide evidence that this was clinically better than land based therapy although this was not to suggest there were no preferences for water based therapy;

 

• there are about 13 users of the Orpington pool with a learning disability – it was about providing alternative therapy for them in the best way, alternative pools are being explored including using QMS;

 

• a Community Health and Wellbeing Centre was the preferred option providing a larger collection of services, other investment directed at prevention and care at home;

 

• The hospital is not preferred as only a quarter or less of the Orpington hospital space was needed;

 

• it was necessary to find the right type of development (Community Health and Well Being Centre or a local health centre) in the right location.

 

In concluding her presentation, the Project Director sought clarification on when the Sub-Committee would like to consider the conclusions from the consultation. The consultation period would end on 29^th October 2012 and following independent evaluation of feedback and public sharing of the report, recommendations from the Bromley Local Clinical Commissioning Committee would be made to the PCT Board on 29^th November 2012.

 

In subsequent questions, Councillor Fookes asked whether a site had been found in Orpington High Street. The Chairman indicated that it was not possible to pre-judge the outcome of consultation - following consultation a business case was then necessary. The Chairman enquired of the time period necessary to produce a business case; the Project Director indicated that it was not possible to confirm until the future direction was known following consultation. Adding to the Project Director’s comments, the Managing Director/Director of Public Health indicated that a business case would be produced as quickly as possible.

 

In reply to a further question on the consultation, the Project Director indicated that all residents in the borough would be leafleted. She would also be attending the Health Overview and Scrutiny Committee at Kent County Council later in the month. Consultation material would also be available at Orpington hospital.

 

In response to a concern that any future development would be left half empty, the Project Director referred to being more demanding of how people work together. The Managing Director/Director of Public Health explained that at Beckenham Beacon there had been a need, and more efforts were now being made, to be more specific in requirements for space. It was intended to learn further from Orpington on how space at Beckenham Beacon could be developed.

 

Councillor Jefferys referred to the linking of GP Surgeries to specialists for real time diagnosis, highlighting the use of such techniques for the future. The Managing Director/Director of Public Health indicated that much more of a similar nature could be undertaken and that efforts would be made to maximise such initiatives through the process.

 

It was necessary to look across Primary Care – health services and new ways of working were not limited to buildings. The Chairman questioned how far such approaches could be taken. There was a fear amongst residents about a loss of service and it seemed that there was less emphasis on delivery.

 

Concerning hydrotherapy, Councillor Mrs Manning had a sense that people were opting for this adding that hydrotherapy had its benefits. Members were advised of the availability of the children’s pool at the Phoenix Centre and a hydrotherapy pool at QMS which currently has vacant sessions. A pool at Sevenoaks and the Riverside pool were also possibilities. Resolving hydrotherapy would be looked in individual clinical care plans as necessary. The Chairman noted the research had stated that there was no clinical evidence for hydrotherapy above land therapy. The matter was for the clinicians and it was necessary to have evidence to show that water based therapy should be prioritised above land based therapy. For people who wanted to make a choice for hydrotherapy, the option of attending QMS was available.

 

The Project Director also advised of a desire to speak with all hydrotherapy users and not just the 13 using Orpington hospital.  However the recommendations look at maximum health gain for the population balanced against individual preferences for people.

 

Leslie Marks referred to money being raised by people for the Orpington pool. There were people who would self refer and she referred to block bookings. She suggested that there was no entrepreneurial approach to using the pool and if there are no referrals a service would cease. The Project Director indicated that there could have been more people to take more sessions and more use could be made of the pool but the problem they were trying to solve was how to make total resources work best for all of the population. She also indicated that the matter had been raised with Mytime with enquiries made on what would make the greatest difference, and whether an injection of capital would make a big difference.

 

The Chairman suggested that the difficulty is meeting the costs of running a standalone pool. It was necessary to look at the best outcomes; the Committee would promote hydrotherapy if there was the evidence for this.

 

Concerning input to the consultation, the Managing Director/Director of Public Health was supportive of both the Committee making a combined response and individuals making a response. Councillor Ruth Bennett highlighted that the consultation leaflet could get mixed up with other material through the letter box; she also suggested using Resident Associations. 

 

It was indicated that the Sub-Committee would respond to the consultation with the response based on comments made in the process so far with the Sub-Committee.

 

Councillor Adams felt that there should be emphasis on responding online in view of the cost of consultation. Councillor Ruth Bennett also suggested having a link on the Council website. Councillor Jefferys suggested that reference be made to encouraging responses electronically.

 

In concluding, the Chairman thanked the Health representatives for attending.

 

RESOLVED that the Sub-Committee support the readiness of proposals for consultation subject to the consideration of comments made in discussion.