What is the consultation about?
This consultation is about community-based services in Newcastle-under-Lyme, Stoke-on-Trent and Staffordshire Moorlands and community hospital beds available for rehabilitation. It is also about proposals to move some of the consultant-led outpatients clinics such as outpatients appointments for skin conditions and minor surgery for things like lumps and hernias from Leek Moorlands Community Hospital to the Royal Stoke University Hospital.
Who is running the consultation?
These two CCGs are responsible for deciding which service providers receive NHS money. They commission (buy) most NHS care including community, mental health and hospital-based services in Northern Staffordshire. They have a legal duty to involve local people in decision making when they think about making large changes to services.
CCGs are led by their GP ‘members’ which means that all decision making is informed by clinical experts. Together, the two CCGs serve approximately half a million people across Stoke-on-Trent, Newcastle-under-Lyme and the Staffordshire Moorlands.
How can I have my say and what do I do if I need help or information in a different format?
To have your say, you can complete the survey online.
If you need information in other formats including hard copies of the survey, Get in touch.
What happens at the end of the consultation? Who is making the decisions?
This consultation will run for 14 weeks from 10 December 2018 to 17 March 2019.
The responses received during the consultation will be analysed independently and a report produced. This report will be presented to North Staffordshire and Stoke-on-Trent CCGs for consideration before any decisions on service change are taken.
The two governing bodies will meet together but as they are separate organisations, they can make separate decisions for each area if they need to. This meeting will be held in public and we will publish all the relevant documents on this website under Decisions and News & Documents.
Once the CCGs’ governing bodies have made their decisions, we will let everyone know the outcome on our websites, via social media and the local media. Then the hard work to implement any changes will begin. We will keep you updated on our progress throughout.
NHS England and the Consultation Institute will monitor and check our decision making process. You can read more about this in Scrutiny & Assurance.
What happens if the CCGs don’t make a decision?
We would review why a decision has not been made and take appropriate action. This may mean, for example, further consultation or data analysis. We would ensure we update all our stakeholders on what the outcome of the decision meeting is and what the next steps would be.
Who is analysing the consultation responses?
The consultation responses will be analysed by an expert team managed by NHS Midlands and Lancashire Commissioning Support Unit (MLCSU). MLCSU is a not-for-profit NHS organisation that offers support to NHS bodies across England to deliver projects like this consultation.
Why waste money on public meetings and engagement activities – wouldn’t it be better spent on NHS services?
CCGs have statutory duties to seek the views of local people and stakeholders when considering changes in the provision of local services. We do this not just because it is a legal requirement but because it is the right thing to do.
We want to know what’s important to you and which services meet your needs. We are keen to explore what changes could be possible. We know that when local people are involved in decisions about their health care, there are better health outcomes as a result.
How long will the changes take? When will they start?
No decision has been made on how we will take forward services in the future. This is why we are asking your views, to help us to make these decisions. Once the CCGs’ governing bodies have made their decisions, we will update you on what the next steps look like. Any change that may be made will not happen straight away.
Case for change
Why do services need to change?
Health and social care services in Northern Staffordshire face some challenges that we must address to make sure patients get the high quality care they deserve. We want to make sure that our health and care system is clinically and financially sustainable. We face a number of challenges, including financial challenges, that mean that we need to look at different ways to deliver our services if we are to continue to offer the best possible care within our limited budget.
We believe the suggested model of care and options in the consultation document will help us offer safe, easy-to-reach services. We want to improve health and wellbeing for local people and better meet their medical needs.
Is this about saving money?
With diminishing resources and increasing pressures on services across the whole of the NHS, we have to be clear that both North Staffordshire and Stoke-on-Trent CCGs are facing financial challenges. Maintaining services as they are is not the best way to spend the Northern Staffordshire pound wisely and to get best value for the public money that we spend.
How we are consulting
What are you doing to make sure those affected have their say?
We have developed a consultation plan based on our Equality Impact Assessment and what we know about our local people and our stakeholders.
We have looked at information about the differences in health needs in each area because we want to make this gap in health inequalities smaller. We will also place particular emphasis on patients and carers. We will also make sure that we give due regard to the groups of people who are listed in the Equality Act 2010 to make sure our proposals do not discriminate against them. We will make sure that we have considered making reasonable adjustments to their needs if there are any unintended consequences of the proposals.
We will also encourage NHS and partner staff, clinicians and politicians to take part in this consultation. We will engage with Healthwatch Stoke-on-Trent and Healthwatch Staffordshire and provide them with many opportunities to respond to the consultation.
To help us with this work, we have analysed our list of stakeholders and we will be checking along the way to make sure that we have heard from representatives of all groups.
Because our proposals cover more than one local authority area, we have asked that a Joint Health Overview and Scrutiny Committee (JHOSC) be formed. We will consult them at key points during the consultation that we will agree with them. Read more about the JHOSC in Scrutiny & Assurance.
Developing our proposals
How did these options you are consulting on come about?
Since October 2017, we have been looking at what services people need and asking people what their views are. This then shaped our proposed model of community-based care.
We then undertook a detailed process of engaging with clinical experts, local people, using addition research and feedback from medical professionals and others to develop our options and test against key criteria to ensure quality, safety, accessibility, and that any options would meet local need, clinical need and meet local and national strategies.
You can read more about this process in our consultation document.
What assurance process did you undertake?
Our proposals were assessed by the West Midlands Clinical Senate. The senate is the key regional source of independent, strategic advice and guidance to help make the best decisions about healthcare for the populations of local areas.
We have also sought advice and worked closely with the Consultation Institute who are the leading independent experts on best practice in public consultations. In addition, our proposals have been scrutinised by NHS England.
Read more about Scrutiny & Assurance.
Who had the final say on what proposals are being consulted on?
The Pre-Consultation Business Case was considered by the CCGs’ governing bodies at a meeting held in public. The final shortlist of options for both community hubs and beds was created at this meeting. This shortlist of options is what we are now consulting on. You can read the papers from this meeting in Decisions.
Do clinicians support these options?
Yes: Our clinicians have been involved throughout the process of developing our proposed model of care and options. Clinicians provided their views on how services could look, as well as helping us to decide which options would deliver the best possible care and health outcomes for our local population.
We will continue to involve our clinicians at every stage – we will be running events, webinars and offering other ways of ensuring they continue to have their say.
What about the growing local demand for health services with all the house building and with people generally living longer?
Consideration of current and modelling the future demand for services is very important and this has been built into our proposals.
Have you thought about people who live in rural locations and those people who rely on public transport?
Accessibility of services is one of the criteria that we would like your views on. We will certainly be taking it into account when looking at the feedback we get.
Our new care model
What are integrated hubs?
Integrated hubs are community-based centres where several services are available in one place, better meeting local patients’ needs and making sure they receive the care they need without going into hospital. You can read our Case Studies to see how this could work in future.
What do you mean by ‘care closer to home’?
Evidence shows that patients are likely to get better sooner if they are sent home quickly. Most people would prefer to be treated at home if possible. Moving care closer to home means that we are looking at how we can deliver more services in the community, rather than in hospitals.
How can you be sure that the right care is in place in the community to support people when they go home?
We would like to reassure people who have raised concerns that home-based care is not yet fully in place. We have recently invested over £24 million in improving the range and quality of community health services such as district nurses, intermediate care teams and specialist nursing teams to make sure that support and care are based around the individual patient with the aim of delivering high quality care, closer to home. You can read more in our consultation document and in our Pre-Consultation Business Case.
Are community hospitals closing?
No decision has been taken on the future of community hospitals. Any decision will only be made after consideration of the outcome of this consultation. Your views are important: they will help inform any future decisions.
Will there still be community beds for rehabilitation?
Our proposal is that there would still be about 132 community beds across our area including 77 rehabilitation beds. You can read more in our consultation document, our Pre-Consultation Business Case and our Spotlight on Modelling Rehabilitation Beds.
Our new model of care will also enable us to reduce our need for community hospital rehabilitation beds. There is strong clinical evidence that people who do not need to be in hospital should not be there, whether that is in a large hospital like Royal Stoke University Hospital or a smaller community hospital. With our new care model we could ensure that those people who are ready to move back home can do so with support of an integrated care team that are based in a hub close to home.
We also want to reassure people that our focus is on providing the highest quality, safe care and that includes any options that include care home beds. You can read about our focus on quality in our Spolight on Quality Inspection.
We want to make sure that people have the right care, in the right place at the right time and where possible, closer to home.
How will the local health service cope during winter without the beds that have been closed?
The rehabilitation beds were not commissioned for assessments for ongoing care to be carried out, or for A&E overflow. They should not be used as waiting rooms for patients who are much better served with care in their own homes or in their assessed permanent place of residence following a health and/or social care assessment.
In August 2016, a spot check was undertaken to identify whether the patients in the community hospital beds needed to be in hospital. This study, carried out across the adult intermediate and rehabilitation beds open across our five community hospitals, showed that 91 per cent of patients were receiving assessments or care that could be carried out at home or a care home or were waiting for another service.
We have been working closely with Midlands Partnership NHS Foundation Trust (MPFT) and University Hospitals of North Midlands Trust (UHNM) to develop a service known as Discharge to Assess to ensure that patients are discharged home from hospital with the right clinical assessment, and with social care support where required and therefore reducing the requirement for an admission into a bed.
Consultant-led outpatients clinics
Why are you moving some clinics?
Currently we run a number of consultant-led clinics for outpatients at Leek Moorlands Community Hospital and at the Royal Stoke University Hospital. These are called ‘Tier 4 services’ because they need a specialist consultant to deliver the service.
We are facing a number of challenges delivering these services in the way we do now. Patients are experiencing very long waiting times for outpatients appointments. Also, because services are split across two sites, clinics are not working to maximum capacity. This is particularly a problem at Leek Moorlands Community Hospital where very low numbers of patients attend some clinics.
We want to move services that have low clinic numbers from Leek Moorlands Community Hospital to the Royal Stoke University Hospital. This would enable us to provide a better, more efficient safer service and ensure our consultants spend more time with patients than travelling.