The Adult Care and Health Overview and Scrutiny Committee’s views are requested.

The Chair introduced this item, explaining that there had been an extensive consultation which had resulted in a strong response from the public and professionals. The revised plans were approved by the NHS Clinical Commissioning Group (CCG) on 9 July.

Dr Paula Cowan, Chair of Wirral Health and Care Commissioning, and Nesta Hawker, Director of Commissioning and Transformation, presented the background on the consultation and the proposals using a presentation (attached to these minutes for information). Survey results and petitions demonstrated the depth of interest in the delivery of health care, and an independent review was undertaken to ensure transparency and avoid bias in the recommendations. Plans were revised as a result and were agreed on 9 July 2018.

At Arrowe Park, feedback from the consultation had been focussed on retention of walk in access, approval of the 24-hour treatment centre, with valuing of all age access, local service, flexibility of appointments and public transport access. There was awareness of the potential issue of public transport access and the need to ensure that it did not affect the aim of providing the best service to patients.

Dr Cowan explained how the usage of Gladstone and Moreton had been examined to determine reasons and patterns for usage and the recommendations met the identified needs. It was acknowledged that educating patients to alternative provision and changes was important and this was planned.

Councillors questioned Dr Cowan on the details and were provided with answers:

·  Extended hours GP appointments would be bookable through existing contact numbers and through the NHS 111 service and access to GPs was an issue being worked on

·  At Gladstone the appointments would be at the Parkfield site within walking distance of Gladstone

·  The new contract for primary care was transforming delivery by broadening the range of alternate provision including physician associates, self-care and social providers as well as GPs which was lessening the pressure on the NHS

·  Peaks and troughs including flu outbreak and Winter increases would be managed better by continual monitoring of demand and by forward planning for anticipated pressures such as vaccinations and managing chronic diseases

·  The date for implementation of the proposals was anticipated as April 2020 and there would be a period afterward for monitoring performance and review

·  Communication was a key aspect to educating the general population to newer roles such as physician associates, and triage would take place in doctor’s surgeries to identify the ideal role to deal with their issue

·  Access by public transport was identified as an issue and a discussion with the council would be welcomed. Pressure may need to be put on operators to provide a service despite them withdrawing several services on the A41

Other witnesses were introduced:

Dr Mark Fraser from the Primary Care Wirral GP Federation then spoke to pay tribute to the CCG on the process and consultation and had concurred that quality access in the local area was a most important aspect and he was happy to support the proposed changes. He explained about the increase in extended hours GP appointments at evenings and weekends. The work was an additional work pressure and there were limits to how much which could be asked of existing GPs, but most practices had begun to open from 8 am to 8 pm and at weekends. It had been noted that there was a high non-attendance rates for pre-bookable attendance rates at the weekend, so there were now more (about 40%) non-bookable appointments.

Dr Abhi Mantgani had been at this Committee earlier in 2019 with concerns at the proposals and had gone on to gather support of 45,000 people. However, he recognised that the CCG had considered feedback and comments and the new proposals reflected the concerns and enhanced the existing service and he now supported the proposals. His centre was open 7 days a week and saw about 21,000 people a year, although he recognised that public transport access was an issue.

Betty Hodgson, the Chair of a GP Patients Federation which represented all of the practices in the Wirral GP federation, welcomed the proposals but requested clarity of what was happening at Moreton and Gladstone so that people knew what was happening regarding appointments.

Alan Grice, co-chair of the Patient Participation Group in Miriam Health Centre, was grateful to the CCG for changing the proposal. He was aware that the loss of any service would be an emotive issue, and there was also details to be worked out on the services but he recognised that the proposals were broadly positive.

Karen Howell, the CEO of the Wirral Community Health and Care NHS Foundation described the services provided through the walk-in centres which were to provide advice and treatment for non-urgent conditions. She felt that the changes would enhance the centres and confirmed that there would be appropriately qualified staff dealing with patients. Staffing in the future was a potential concern as there were not enough people coming into the professions to cover the potential need. Schoolchildren were being given presentations so they could consider it as a career path.

Anthony Middleton, Chief Operating Officer of Wirral University Teaching Hospital NHS Foundation Trust gave his views of the revised plans and the impact on his service. He welcomed the proposals as it would provide a more consistent service. At Arrowe Park, some emergency appointments could be ‘de-escalated’ from the Emergency Department (ED) to clinicians under the new arrangements which would take some pressure off the ED.

The Chair thanks all of the contributors for their input at the meeting.

Councillor Yvonne Nolan moved the following recommendation, seconded by Councillor Kate Cannon:

‘It is resolved that the Wirral Adult Health and Care Scrutiny Committee thanks the officers of Wirral CCG for their report and for providing responses to the questions of the committee.

Further that this committee disagrees with the decision of Wirral CCG to close two of the current 5 Walk In and Minor Injuries units because:

a)  the decision has failed to take into account the access difficulties that will result from people having to access the proposed new UTC at Arrowe Park by public transport. We ae of the view that the report has not taken into account recent proposals made by transport operators to reduce or remove buses on key routes that would cause insurmountable access problems for people in some of the most deprived communities.

b)  The proposal fails to provide clarity on how and where the ‘alternative GP appointments’ will be provided. The report is vague and uses mileage to identify distances that people may have to travel to reach alternative provision, but does not identify the public transport links that would have to be used.

c)  It is also not clear how the additional GP resources will be provided, or how the additional housing developments included in Wirral’s local plan have been taken into account when reaching the decision

This committee requests that the Joint Adult Health and Care Scrutiny committee take these views into account during its consideration of the Urgent Care proposals’

The Motion was voted on and declared lost.

Councillor Phil Gilchrist moved the following recommendation, seconded by Councillor Moira McLaughlin:

‘That the Adult Care and Health Overview and Scrutiny Committee

i.  Recognises that Wirral Health and Care Commissioning have consulted extensively on the options under consideration and that this produced a substantial public call for the retention of all readily accessible all age walk in facilities. The response of the commissioners to this is appreciated. However it is also apparent that there has been little formal consultation in the Moreton area regarding the change to provision in that community and that concerns have been expressed over the sufficiency of the replacement services there.

ii.  Records its appreciation of the steps taken by Wirral Health and Care Commissioning to optimise services within the available funding.  When taken together with the funding provided for the provision of additional appointments in local surgeries with doctors and /or suitably qualified and experienced staff committee looks for an overall improvement in the services offered. This, though, has to be seen in the context of the mandated provision of an Urgent Treatment Centre on the Arrowe Park site which has a major influence on the availability of the community facilities. 

iii.  Understands that the reduced hours of operation for the facilities at Victoria Central hospital and the extended hours of operation in the Birkenhead area are based on a detailed analysis of their usage. The committee accepts the assurances offered by Dr Simon Delaney regarding the impact of service changes on patients in the New Ferry area. It is also apparent that the use of facilities by residents of Western Cheshire also plays a major part in the demand for services and that this has been recognised with the retention of facilities at Eastham.

iv.  Appreciates that Wirral Health and Care commissioning recognise that the availability and ease of transport is key factor over which they have no control and limited influence but it is clear to this committee that this remains an issue of public concern and uncertainty.

v.  Notes the distribution and availability of extended access provision, as set out for 2018 /19, and looks forward to this being replicated in future years. However a key concern remains around the ease of access to these services, the provision of facilities in western Wirral and the difficulty that residents from the Hoylake and West Kirby areas face in travelling to Arrowe Park Hospital, the Walk in service there and the proposed 24 hour Urgent Treatment Service.

vi.  Observes that the Clinical Senate Review published in December 2018 recommended a stepped approach to the changes, highlighted the issues of streaming and flow within the hospital, silo working and lack of collaboration between organisations. Committee looks for assurances that these issues will be resolved before the new service is launched, 

vii.  Committee wishes to be kept informed of the strategic planning for the revised services at each of its meetings and remains concerned that the 111 service will be sufficiently developed to offer the advice and assistance patients expect.  Committee also asks that Wirral Health and Care Commissioning continue to work with Merseytravel to tackle the transport issues.  and requests full access to the promised monitoring reports. Committee requests that a report covering the first six month of operation of the new services should be presented towards the end of 2020.’

The recommendation was voted on and carried, although Councillor Gilchrist asked that both recommendations be supplied to the Joint Health Scrutiny meeting on 30 July for consideration.

Members discussed the issues around public transport and noted that Merseytravel were franchisers rather than providers of bus services. It was noted that bus operators would only run a service if it was sufficiently profitable. It may be possible for Councillors to meet as a Transport Group and speak with Merseytravel, the Combined Authority, Arriva and Stagecoach to encourage them to operate services to medical facilities.

Councillor Moira Mclaughlin proposed, seconded by Councillor Les Rowlands that she write to the Leader of the Council about the concerns regarding public transport access to the medical facilities and ask if he would oversee a Transport Group of the Council.

RESOLVED: That the Adult Care and Health Overview and Scrutiny Committee

1)  Recognises that Wirral Health and Care Commissioning have consulted extensively on the options under consideration and that this produced a substantial public call for the retention of all readily accessible all age walk in facilities. The response of the commissioners to this is appreciated. However it is also apparent that there has been little formal consultation in the Moreton area regarding the change to provision in that community and that concerns have been expressed over the sufficiency of the replacement services there.

2)  Records its appreciation of the steps taken by Wirral Health and Care Commissioning to optimise services within the available funding.  When taken together with the funding provided for the provision of additional appointments in local surgeries with doctors and /or suitably qualified and experienced staff committee looks for an overall improvement in the services offered. This, though, has to be seen in the context of the mandated provision of an Urgent Treatment Centre on the Arrowe Park site which has a major influence on the availability of the community facilities. 

3)  Understands that the reduced hours of operation for the facilities at Victoria Central hospital and the extended hours of operation in the Birkenhead area are based on a detailed analysis of their usage. The committee accepts the assurances offered by Dr Simon Delaney regarding the impact of service changes on patients in the New Ferry area. It is also apparent that the use of facilities by residents of Western Cheshire also plays a major part in the demand for services and that this has been recognised with the retention of facilities at Eastham.

4)  Appreciates that Wirral Health and Care commissioning recognise that the availability and ease of transport is key factor over which they have no control and limited influence but it is clear to this committee that this remains an issue of public concern and uncertainty.

5)  Notes the distribution and availability of extended access provision, as set out for 2018 /19, and looks forward to this being replicated in future years. However a key concern remains around the ease of access to these services, the provision of facilities in western Wirral and the difficulty that residents from the Hoylake and West Kirby areas face in travelling to Arrowe Park Hospital, the Walk in service there and the proposed 24 hour Urgent Treatment Service.

6)  Observes that the Clinical Senate Review published in December 2018 recommended a stepped approach to the changes, highlighted the issues of streaming and flow within the hospital, silo working and lack of collaboration between organisations. Committee looks for assurances that these issues will be resolved before the new service is launched, 

7)  Wishes to be kept informed of the strategic planning for the revised services at each of its meetings and remains concerned that the 111 service will be sufficiently developed to offer the advice and assistance patients expect.  Committee also asks that Wirral Health and Care Commissioning continue to work with Merseytravel to tackle the transport issues.  and requests full access to the promised monitoring reports. Committee requests that a report covering the first six month of operation of the new services should be presented towards the end of 2020.

8)  Write to the Leader of the Council to see if he will oversee the putting together a Transport Group of the Council with Members drawn from the Business Overview and Scrutiny Committee, Environment Overview and Scrutiny Committee and Adult Care and Health Overview and Scrutiny Committee, and possibly the Cabinet Member for Environment and Climate Change.