Issue - meetings
Urgent Care Review
At the request of the Cheshire West and Chester (CWAC) People Overview and Scrutiny Committee - a Joint Scrutiny Meeting has been convened to consider the impact of the Wirral Clinical Commissioning Group proposals for Urgent Care Services. CWAC have determined the proposed changes to urgent care to be a substantial development / substantial variation to the health service.
Report Papers and Minutes of the meeting of the Wirral Adult Health and Care (meeting jointly with Members of the Children and Families Overview and Scrutiny Committee) (Minute 28, 12 November) attached. (Pages 11 – 164)
Urgent Care Transformation Update additional background briefing papers, circulated to all Wirral Councillors 6 November 2018, also attached.
(Pages 165 – 242).
- Urgent Care Consultation Cover Report 121118, item 4 PDF 117 KB
- APPENDIX 1 NHS Wirral CCG Urgent Care Consultation Document 200918, item 4 PDF 164 KB
- APPENDIX 2 Case for Change, item 4 PDF 4 MB
- APPENDIX 3 Urgent Care Consultation Presentation, item 4 PDF 916 KB
- 1. Wirral Wide demand, item 4 PDF 261 KB
- 2. MIUs (3), item 4 PDF 496 KB
- 3. WICs (3), item 4 PDF 478 KB
- 4. Pharmacy, item 4 PDF 252 KB
- 5. Footfall for Arrowe Park site, item 4 PDF 181 KB
- 6. Financial Assumptions, item 4 PDF 98 KB
- 7. A&E APH Wirral wide activity, item 4 PDF 92 KB
- 8. Conclusion, item 4 PDF 138 KB
- OSC Briefing Paper_11.12.18_final, item 4 PDF 208 KB
- Appendix 1. Engagement Timeline, item 4 PDF 95 KB
- Appendix 2. Governing Body Urgent care transformation 6.02.18, item 4 PDF 185 KB
- Appendix 3. Clinical Senate Terms of Reference, item 4 PDF 504 KB
- Appendix 4. VSA Summary, item 4 PDF 899 KB
- Appendix 5. Attendance List - Value Stream Analysis Workshop, item 4 PDF 38 KB
- Appendix 6. Listening Exercise Summary 09.02.18, item 4 PDF 649 KB
- Appendix 7. Options Briefing_discounted options_07.06.18_v2, item 4 PDF 202 KB
- Appendix 7a. Urgent care financial and activity options, item 4 PDF 68 KB
Chair’s Opening Remarks.
The Chair welcomed Members, Officers and members of the public to the meeting. With the agreement of the Committee the Chair then invited visiting Councillor Phil Gilchrist and Councillor Chris Carubia to the table. She informed the meeting that as Ward Councillors for Eastham Ward (the boundary of Wirral and Cheshire West and Chester) they had a detailed understanding of access to healthcare in that location and could provide the Committee with information on issues that may affect residents as a result of the proposal for the redesign of urgent care. It was noted that the visiting Councillors would not be entitled to a vote during the meetings proceedings.
- Mr Simon Banks – Chief Officer, Wirral Clinical Commissioning Group (CCG)
- Dr Paula Cowan, G.P. Eastham Group Practice and Clinical Lead for Urgent Care for Wirral CCG
- Ms Jacqui Evans – Assistant Director Planned Services, Wirral CCG
- Mr Graham Hodkinson – Director for (Adult) Care and Health (Wirral)
- Ms Laura Marsh – Director of Commissioning, NHS West Cheshire CCG
- Dr Sue Wells - Chair, Wirral CCG
Doctor Paula Cowan and Ms Jacqui Evans provided the Committee with an overview of the proposals to alter the method by which patients would access urgent care treatment. Members noted that the proposals had been open to public consultation from 20 September 2018 to 12 December 2018. Following which, feedback received during the consultation period and other evidence would be reviewed by the NHS Wirral CCG Governing Body before a final decision on a future model of care was taken
Doctor Cowan and Ms Evans’ report informed that Wirral was not unique in the issues of people not always being able to get an urgent appointment at their own GP practice and how confusion about alternative services resulted in many people choosing to go to Wirral’s only Accident and Emergency (A&E) Department at Arrowe Park Hospital.
Members were apprised that NHS England had mandated a number of new service developments which included an improved NHS 111 service and the introduction of Urgent Treatment Centre’s across the country. The national developments aimed to make urgent care services work better for patients and to ensure that Accident and Emergency (A&E) Departments dealt with the most poorly and vulnerable people. Members were informed that it was Wirral CCG’s intention to locate the Urgent Treatment Centre (UTC) for Wirral at Arrowe Park Hospital by developing the existing Walk in Centre. This location was believed to provide the best clinical model for patients as the UTC would be located adjacent to the Accident and Emergency Department and would provide a single ‘front door’ to access urgent care on the Arrowe Park site - to ensure A&E staff could concentrate their clinical skills on emergency care.
Doctor Cowan and Ms Evans’ report informed that the UTC would offer bookable appointments and a walk-in facility and, as part of this consultation, the CCG was asking for people’s views on how many ... view the full minutes text for item 4
Further to the meeting of the Adult Care and Health Overview and Scrutiny Committee 12 September 2018 (Minute 20(2) refers), the Adult Health and Care and the Children and Families Overview and Scrutiny Committees are to consider the Wirral Clinical Commissioning Group proposals for Urgent Care Services.
- APPENDIX 1 NHS Wirral CCG Urgent Care Consultation Document 200918, item 28 PDF 164 KB
- APPENDIX 2 Case for Change, item 28 PDF 4 MB
- APPENDIX 3 Urgent Care Consultation Presentation, item 28 PDF 916 KB
- 1. Wirral Wide demand, item 28 PDF 261 KB
- 2. MIUs (3), item 28 PDF 496 KB
- 3. WICs (3), item 28 PDF 478 KB
- 4. Pharmacy, item 28 PDF 252 KB
- 5. Footfall for Arrowe Park site, item 28 PDF 181 KB
- 6. Financial Assumptions, item 28 PDF 98 KB
- 7. A&E APH Wirral wide activity, item 28 PDF 92 KB
- 8. Conclusion, item 28 PDF 138 KB
- Webcast for Urgent Care Review
The Chair invited Dr Paula Cowan, Medical Director Wirral Clinical Commissioning Group and Eastham GP and Jacqui Evans, Assistant Director Unplanned Care and Community Care Market Commissioning to provide an overview of the Urgent Care Consultation.
Dr Cowan explained that the meeting would provide an opportunity for interested parties to receive an update on progress so far, key messages and the consultation as it stood at this moment in time. She hoped that the meeting would also inform Councillors, and dispel some of the myths being propagated in social media and the press.
Assistant Director Unplanned Care and Community Care Market Commissioning introduced a presentation that set out the background to the Urgent Care Review and methodology of the consultation process. She informed the Committee of the key messages and proposals to help alleviate pressures on the Accident and Emergency (A&E) Service at Arrowe Park and provide a better patient experience both for A&E users, Urgent Care Treatments, and generally to help provide a consistent offer of access to NHS treatment across Wirral utilising a GP led service.
Ms Evans explained how the key drivers for change included pressures on A&E, leading to unacceptable waiting times, and the need to re-configure services as detailed in the consultation options, taking into account locality demographics and needs.
The Overview and Scrutiny Committees were apprised that one of the common themes from the CCG’s engagement activities since 2009 was the view that people were confused about the range of urgent care services available due to different service offerings and opening times - further explored during focus groups and visits to urgent care venues completed in February 2018. It was highlighted that people could not always obtain an urgent appointment at their own GP practice and this, combined with the confusion about alternative services, resulted in many people choosing to attend Wirral’s only A&E Department at Arrowe Park. Members were informed that Wirral was not unique in facing these issues and NHS England had mandated a number of new service developments which included an improved NHS 111 service and the introduction of Urgent Treatment Centre’s across the country.
Ms Evans’ presentation provided further information on a wide range of issues that included:
· NHS change assurance and scrutiny of work to date;
· Internal Governance arrangements, providing oversight and information on progress;
· Independent review and EIA (equality impact assessment); and
· Meaningful consultation utilising workshops, online consultation survey, public meetings, postcard drops and information posters in GP surgeries.
The Overview and Scrutiny Committees were also provided an update on how additional independent challenge had been embedded in the process recognising points of view and comments from Healthwatch Wirral, Medical Professionals and Workforce including GP Federations.
A broad selection of statistical evidence underpinning the consultation was provided to Members as part of the presentation and associated agenda papers.
The Chair invited questions from both Overview and Scrutiny Committees. Points raised included:
· Possible issues faced through the implementation of a GP led service, given recent ... view the full minutes text for item 28