Frequently Asked Questions

Introduction

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?

Local NHS organisations North Staffordshire and Stoke-on-Trent CCGs are both legally responsible for this 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?

The consultation is now closed. However you can still read about the proposals and ask any questions you may have: Get in touch.

 

What happens at the end of the consultation? Who is making the decisions?

This consultation is now closed. The responses received during the consultation are being analysed independently and a report will be 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.

How will you know you've got it right? What will you do if you haven't?

Before implementation, we will agree a benefits framework with patients and clinicians that covers improvements in clinical outcomes, patient and staff experience, and delivery of financially sustainable services. The agreed measures will be used in later phases to track progress and ensure that implementation is delivering as expected. Post-implementation, the benefits framework will allow us to compare the overall impact of the change with the pre-implementation situation. From this, we can note and build on successes and identify and learn from unintended consequences. The benefits framework will take into account the outcomes-based specification proposed for integrated care teams and hubs (see Appendix 1 of the Pre-Consultation Business Case for further details).

 

Who is analysing the consultation responses?

The consultation responses is being 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 asked 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.

 

Health care strategy 

How do these plans for northern Staffordshire align with STP / local strategy?

Alignment to national and local strategy is a core requirement for our future care configuration.

The Pre-Consultation Business Case gives assurance that our plans are aligned with the strategic plans for the CCG, Local Authorities,  Health and Wellbeing Board and the STP.

Our proposals have widespread support from stakeholders within the local health economy. Together We're Better are active partners in the process engaged around the options development, appraisal and costing. They are supportive of the direction of travel.

 

How do these plans for northern Staffordshire align with national strategy?

Alignment to national and local strategy is a core requirement for our future care configuration.

The draft model of care we have developed for our community services aims to meet the needs of the local population and deliver the right care in the right setting. This is consistent with the NHS Long Term Plan, the GP Forward View, and the Five Year Forward View for Mental Health

You can read more in our Pre-Consultation Business Case.

 

How do you intend to get integration between social and health care when social care is so challenged currently?

Both Stoke-on-Trent City Council and Staffordshire County Council have agreed to align and integrate their community wellbeing teams and social care teams around the integrated care hubs which will be reflected in the refresh of the Better Care Fund plans for 2018-19 and new submission for 2019-20.

 

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 developed a consultation plan based on our Equality Impact Assessment and what we know about our local people and our stakeholders.

We also looked at information about the differences in health needs in each area because we want to make this gap in health inequalities smaller. We placed particular emphasis on patients and carers. We also ensured we gave 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. Through this work we will also ensure we considered making reasonable adjustments to their needs if there are any unintended consequences of the proposals.

Throughout the consultation, we also encouraged NHS and partner staff, clinicians and politicians to take part in this consultation. We also engaged Healthwatch Stoke-on-Trent and Healthwatch Staffordshire and provided them with opportunities to respond to the consultation.

To help us with this work, we analysed our list of stakeholders and we checked along the way to make sure that we heard from representatives of as many groups as possible.

Because our proposals cover more than one local authority area, we asked that a Joint Health Overview and Scrutiny Committee (JHOSC)  be formed. We consulted them at key points during the consultation. Read more about the JHOSC in Scrutiny & Assurance.

 

The CCG has been asking people what they want for two and a half years. Why has this taken so long?

To get to consultation, it has been a long and detailed journey. We have been listening to people, gathering and analysing lots of information, developing our proposed model of care and short-listing our options for consultation. 

You can read more in Our Journey

 

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 additional 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.

You can read more about how we developed our options in our consultation document and our Pre-Consultation Business Case

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 also continued to involve our clinicians at every stage.

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.

What modelling of local health needs has informed the decision around hub locations? And what projections have been made based on poverty deprivation, life expectancy of population? How will the additional/new 6,000 homes in Cheadle be factored in?

Consideration of current and modelling the future demand for services is very important and this has been built into our proposals.

Having been mindful of the need to be fit for the future including local demographic change predictions, we have also considered the 2011-2031 Local Plans for Stafford Borough Council, Staffordshire Moorlands District Council and the Joint Local Plan for Stoke-on-Trent City Council and Newcastle-under-Lyme Borough Council. We will continue to work closely with our local authority partners to ensure that our proposals are aligned with future housing or development growth plans or footprints.

You can read more in our Pre-Consultation Business Case.

 

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.

How did you decide how many hubs to have? Why are there two hubs in Stoke-on-Trent but only one in the Moorlands?

There are 98,000 people living in the Moorlands and 253,500 people living in Stoke-on-Trent (north and south combined).

When reviewing the options, the technical group looked at clinical sustainability, national and local strategy and affordability. They felt it would be difficult to deliver care across two hubs in the Moorlands. 

You can read more in our Pre-Consultation Business Case.

 

Will integrated care teams be based in the hubs?

Under our new model of care, our integrated care teams would be based at the four hubs and would work closely with local GPs. We think this would help improve working relationships between primary care, the voluntary sector, community-based services and specialist services. 

 

Will integrated care hubs be for all ages? How will the hubs encompass the young people?

Our proposed model of community multi-disciplinary working takes a proactive approach to delivering the care that people need, aiming to prevent or identify early deterioration in health status, working with each person and their family or carer to help them help themselves. It will be available to all people over 18 within North Staffordshire and Stoke-on-Trent but is currently focused on those people with multiple long-term conditions and/or over the age of 65.

 

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.

Community rehabilitation beds

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 Spotlight 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. 

 

Why are the CCG using care home beds that are not deemed fit by the CQC? How will you guarantee they are safe and of a high standard?

The quality of service provided in care homes is of paramount importance. They are checked by NHS Contracting Quality measures, Monthly contract review Boards, Quality check visits, Visits by Healthwatch, GP cover is commissioned as part of MultiDisciplinary Team approach to care, Minimum staffing levels specified.

We will only use care homes that the CQC rates at least “good” and that have unused facilities suitable for the assessment and short-term support of patients. If the CQC has concerns, we work with them to rectify the problems and would suspend placements to the care homes if the concerns were not addressed as would the Local Authority.

You can read more in our Pre-Consultation Business Case and Spotlight on Modelling Rehabilitation Beds

 

Caring for vulnerable people in nursing homes will not deliver best outcome.

Our proposed model of care demands that vulnerable patients have integrated care plans which set out outcomes-based care (such as restoring/retaining independence) over the coming 12 months. Care plans will be created by community nurses following patient assessment at home. MDT will discuss/approve plans with reference to a consistent template of good care planning.

 

What plans are there for more care homes?

As part of our Integration agenda, the CCGs are working with both local authorities to understand future demand and requirements. Options for additional care home provision are being considered by both local authorities with a particular focus on the Moorlands and Stoke on Trent. Commissioners have also been working with existing homes to grow the market with a number of homes adding additional capacity, e.g. Bradwell Hall is building a new unit and Guardian Care has just opened a specialist male unit. This will help to support more complex patients in the most appropriate environment.

 

Why is option 6 the preferred option for the location of community rehabilitation beds? How was this decided?

Option 6 scored highest for affordability as it has the lowest recurrent costs, has no additional capital requirements due to the PFI at Haywood, and no additional bed costs. It scored highest for all criteria except for Quality. We know people have concerns about the quality of care at care homes, but we have plans to make sure we can uphold high NHS standards if this option is chosen. 

Options 1-5 each require some initial investment to fix the backlog of maintenance, or to spend on new buildings. Only option 6 has no initial investment cost (money needed up-front to make sure the sites can open and deliver services safely).

There are expenditure costs (money needed to add the right number of beds to each hospital site in order to reach the 132 total for each option) involved for options 1-4, but not for options 5 or 6.

Commissioned community hospital beds cost on average £2,100 per bed per week. Care home beds cost on average £1,000 per bed per week.

So Option 6 is the most affordable option.

You can read more in our Pre-Consultation Business CaseSpotlight on Modelling Rehabilitation Beds and Spotlight on Finance

 

What will the 55 beds at Leek be used for under Option 2?

Under Option 2, patients would receive assessments in the 55 beds at Leek Moorlands Community Hospital.

 

Why are there no rehabilitation beds for the Staffordshire Moorlands community? This is isolating patients.

We have six options for location of rehabilitation beds, which include Leek Moorlands Community Hospital and Cheadle Community Hospital. Option 6 also allows for beds in care homes in flexible locations.

You can read more in our Pre-Consultation Business Case and Spotlight on Modelling Rehabilitation Beds 

 

Workforce

Quality care needs well-qualified staff in adequate numbers. How will this be funded and planned for? What is being done to increase recruitment?

Having recognised that Northern Staffordshire has been disproportionately affected by the GP recruitment and retention crisis, there are a number of locally tailored interventions to deliver the workforce required for the sustainability of general practice and proposed new models of care.

A robust set of actions have been developed by MPFT which includes training for all qualified nursing staff to support rapid assessments across all commissioned bed bases.

We will use local health needs assessments and risk stratification to identify the capacity requirements at each hub location. Underpinning this will be assessments of training needs, skill mix requirements, and refreshing our approach to recruitment and retention, for example, for senior nurse leads.

You can read more in our Pre-Consultation Business Case and Spotlight on Workforce

 

How are newly qualified doctors and nurses from the medical school at Keele being used by the NHS? Is there some kind of obligation to work locally?

Keele University have a world leading primary care research institute, and an established track record of recruiting and retaining academic GPs both locally and nationally. Keele continue to offer opportunities for GPs to undertake postgraduate research within the Research Institute as part of an academic portfolio career. Keele have also recently established an academic general practice in partnership with local GPs. It is the only one of
its kind in the UK and its focus is to recruit and retain clinical academic GPs and allied health professionals. Besides raising the quality of general practice in the locality it also fosters research, development and innovation.

There has been substantial investment with the British Medical Journal to develop a campaign to promote Northern Staffordshire as a good place to work as a GP.

 

Buildings

What happens to patients in the interim whilst building work is underway? (Leek and Cheadle)

For the Leek (Rebuild) option, local estates leads noted that decant costs would be required (c.£2m) to deliver services offsite, whilst construction on the leek site is under way. To avoid incurring this cost, and support achievement of the overall system affordability, the provider noted it would look to utilise existing estate (in the locality) to accommodate hub service provision whilst building works are undertaken on the Leek site.69 On this basis, the financial analysis for the Leek (Rebuild) option, does not include the decant costs.

You can read more in our Pre-Consultation Business Case.

 

What happens to the sites that aren't chosen? (Staffordshire Moorlands)

If Cheadle is not selected as the site for the Moorlands Hub, the NHS could sell the site for development. There may be an opportunity to ‘parcel’ the site with adjacent land owned by the County Council. The NHS and County Council would explore whether there is a need and a viable business case for development of a ‘health and care campus’ on this plot, including some combination of GP surgeries, residential/nursing and/or Extra Care housing. Alternatively, it could be sold for residential housing development.

If Kniveden is not selected as the site for the Moorlands Hub then the County Council will continue to explore whether it could be developed as a nursing home to address the deficit in nursing home capacity in this area. Although not co-located, there may be an opportunity to link the services provided at the Hub with a nursing home, as they are geographically very close.

You can read more in our Pre-Consultation Business Case.

 

Building are not just costs - they are also assets.

For the Leek (Rebuild) option, MPFT, the Technical Group and wider stakeholders considered many points including maximising existing assets. They conculded that the rebuild of Leek Hospital would ensure that existing NHS assets are maximised; rather than divesting of the site to purchase a new site in Leek town centre, which would involve more transaction costs.

You can read more in our Pre-Consultation Business Case.

 

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.

 

How is the relocation of outpatients services from Leek Moorlands Community Hospital to Royal Stoke University Hospital (RSUH) equitable?

By providing specialist clinics across geographically split sites, we are not maximising the capacity available and we do not have equity of service and core consistent offer across our community hospitals. By co-locating these in one place we could serve a wider population and more clinics could be provided, contributing to a reduction in waiting times across the board.

We can also improve individual patient journeys through ensuring that clinics can access the most appropriate diagnostics on site rather than having to refer to RSUH following a community based outpatient appointment for more specialist tests.

Patients will still be offered choice in terms of date and time of appointment in line with their constitutional rights if they continue to choose to attend RSUH but will also continue to be offered other providers such as East Cheshire where they require access to these services.

 

Travel and Transport 

There has been no account taken of 'rurality'. Poor quality of roads, remoteness of patients and relatives, reductions/non-existent public transport. Are you working with the councils to discuss putting on new bus routes to serve the new hubs?

All of the options have been developed having considered many factors, including accessibility (travel times and distances and public transport links). 

Our Pre-Consultation Business Case does recorgnise that there needs to be a balance between providing a range of choices without compromising quality. We know that travelling times are a key factor in patient experience for some of our more rural populations.

We recognise from feedback received in Reference Group sessions that accessibility by public transport is an important factor for our local population. The approach using Google maps data considers the time taken by bus from each ‘sub locality’ to the nearest site in the option by bus. In the Moorlands, Cheadle appears to be the most accessible, closely followed by Leek.

Parking is also of high importance for the Reference Group, and each hub option offers free car parking on site, except for Haywood. Parking details are outlined in Appendix 7 of the PCBC.

A group of professionals and experts from the health community and local authorities narrowed down the proposals against hurdle criteria: Affordable, In line with local and national health strategies, Clinically sustainable.  A reference group then scored the options against criteria they felt were most important which they had previously defined: Would deliver quality care to patients in the future, Meets need, Accessible.

You can read more in our Pre-Consultation Business Case.

 

What consultation has been conducted with staff that will deliver these options?

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.

 

Finance 

Where is the money coming from? Why is the most preferred option the most expensive one?

All the options are cost neutral. To understand the affordability of the options across all localities, their impacts in terms of expected costs and benefits must be considered in the context of CCG spend and provider in system income. This has been done through comparing the growth in CCG income (allocation from NHS England) and hub costs (as a result of increased activity, cost inflation, additional recurrent costs and the additional depreciation from new estates).

Analysis suggests the breakeven point should be achievable over the period 2018/19 to 2022/23, i.e. that costs will rise at a rate no higher than income growth. 

Stoke-on-Trent City Council has confirmed its willingness to fund the capital requirements (£13.2 million) for the South of Stoke-on-Trent development to enable an integrated care hub to be provided alongside the existing planned development of a primary care facility on the same site. They would therefore own the new build facility and would lease the premises to health partners.

Midlands Partnership NHS Foundation Trust (MPFT) has confirmed its desire to fund the capital requirements (£31.9 million) for re-developing the other community hospitals sites in line with final decisions reached after the formal consultation. This aligns to their wider strategy for investment and service development.

You can read more in our Pre-Consultation Business Case or Spotlight on Finance.

 

What are the costings for option 2B for the community rehabilitation beds?

The estimated capital expenditure (the initial investment needed to make sure the site can open and deliver services safely) for 2B is £9.36m. The costs of building or refurbishing plus any costs for creating access to sites, plus fees and costs for planning, works and equipment were all taken into account.

The estimated Net Present Cost (used to compare the total lifetime cost and show which hub location may represent the best value for money in the longer term) for 2B is £10.54m.

See the Spotlight on Finance to compare all the options.

 

Who has assessed the Leek Moorlands as needing £3m to bring it up to standard?

The backlog maintence costs for each estate were sourced from SSOTP analysis and Estates Return Information Collection (ERIC) returns. You can read more in our Pre-Consultation Business Case or Spotlight on Finance.

 

Why do we need an extra £7.8m to get to 55 beds when Cheadle already had 88?

All our options have been costed fully including the additional investment for the option using beds at Cheadle Community Hospital. This investment includes refurbishing the existing hospital to make it fit for use and ensure a high quality, safe service. You can read more in our Pre-Consultation Business Case or Spotlight on Finance.

 

Other

Why have you taken smoking weight management exercise from GPs?

We are working in partnership with public health and prevention to wrap services such as smoking cessation, weight management, drug and alcohol support services and tier 1 and tier 2 prevention services around the hub. We are also working with the voluntary sector and primary care to further enhance and develop the voluntary sector offer around advice and support and social prescribing which will form part of the offer to this locality delivered centrally from the Hub.

 

Why did you use Eventbrite for event bookings - a US based company? Why not use our universities or Support Staffordshire for consultations?

Eventbrite is only used for the event booking system. The consultation is being managed and analysed 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.

 

Was information sent out to proposed participants in advance of the public events so that they could scrutinise proposals in advance?

We did not send out hard copies but promoted the website link so that people could access informaiton or call us for hard copies. At the events, everyone was provided with hard copies of consultation documents including Spotlight documents.